


Differential Diagnosis

by 7PercentSolution, J_Baillier



Series: You Go To My Head [17]
Category: Sherlock (TV), Sherlock Holmes & Related Fandoms
Genre: Alternate Universe, Alternate Universe - College/University, Alternate Universe - Medical, Angst, Animals are therapeutic, Autism Spectrum, Bullying, Disability, Don't copy to another site, Especially when people just disappoint you, Family Drama, Family Dynamics, Friends to Lovers, Gen, General practice, Gynaecology & obstetrics, John being a badass, Loneliness, M/M, Medical Conditions, Mental Breakdown, Mental Health Issues, Prequel, Sherlock as a medical student, Surgery, academic rivalry, confidence issues, early relationship jitters, neurosurgery, psychiatry
Language: English
Status: Completed
Published: 2020-04-25
Updated: 2020-06-28
Packaged: 2021-03-02 03:27:41
Rating: Teen And Up Audiences
Warnings: No Archive Warnings Apply
Chapters: 22
Words: 109,834
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/23838334
Author URL: https://archiveofourown.org/users/7PercentSolution/pseuds/7PercentSolution, https://archiveofourown.org/users/J_Baillier/pseuds/J_Baillier
Summary: During his fourth year of studying medicine at Cambridge, Sherlock is certain that nothing could be worse than the gynaecology & obstetrics rotation he’s just managed to muddle through. Little does he know that it will be the following course — psychiatry — that will pose the greatest threat to the secret he’s struggled to keep. Paired with Sebastian Wilkes who’s had it in for our fledgeling doctor on the Spectrum since year one, Sherlock will need to be on his best game to keep his neurosurgical career dreams alive.
Relationships: Mycroft Holmes & Parents, Mycroft Holmes & Sherlock Holmes, Sherlock Holmes & Parents, Sherlock Holmes/John Watson, Sherlock and his fellow medical students, Sherlock and medical school teaching staff
Series: You Go To My Head [17]
Series URL: https://archiveofourown.org/series/392395
Comments: 821
Kudos: 302





	1. It Can Only Get Better From Here

**Author's Note:**

> [[an index and guide to all of J. Baillier's Sherlock stories](https://archiveofourown.org/works/25011148)]

When the door of his room closes with a click behind him, Sherlock musters up the strength to strip off his clothes and pull on his pyjamas. He'd changed out of his white coat and scrubs at the hospital but hadn't taken a shower because the facilities at the hospital make him cringe. Now, his tired mind suspects that a discerning nose could still pick up on the aromas of disinfectant and humans in labour in which he's been marinated.

It's Saturday morning, and most of his peers at Cambridge's medical programme will have been asleep since the earlier hours of the morning after celebrating the end of the Easter term. Judging by the numerous posters dotting the hallways, many parties had been thrown last night. Their coursework had ended four days earlier with the gynaecology & obstetrics OSCE exams, the re-sit of which had been yesterday morning. After enduring a repeat of the stations he'd failed on the first try, Sherlock had headed straight to the Delivery Unit at the University Hospital NHS trust's Rosie Hospital to continue his remedial practical rotation. The other students who had failed the OSCE were not obligated to do such service — no, Sherlock had found himself in the enforced role of a _special_ case. He had been told, flat-out, that he needed more exposure to gynae patients to pass the course evaluations. Apparently, he hadn't, quote, ' _met the course's educational goals for patient support and communication'_.

To say that it was frustrating was putting it mildly. He knew all the theory and related anatomy and hormonal physiology like the back of his hand. He'd been fine with the operative side of the field and had mastered quickly the small gynaecological procedures every student was expected to know, taking every chance he could to assist in theatre with major cancer surgery, and endometriosis surgery. Once he'd established with some of the gynaecological surgeons that he had already amassed some basic skills in endoscopic technique, they'd let him do a laparoscopic sterilisation — under careful supervision, of course. That day in the OR had been, by far, his most pleasant memory from this term. After all, positioning and inserting the clips to render ovarian tubes dysfunctional should be quite perfect elementary training for positioning and employing clips on cerebral arteries.

He'd have been fine — quite content, in fact — if they'd have let him choose where to do this remedial service. But no. It just _had_ to be bloody obstetrics. He'd been told his remedial period was to focus on normal vaginal deliveries instead of being in the OR. Not that he would have wanted to enter the Labour Unit's theatres anyway. All the surgery performed there was messy, unrefined and uninteresting: suturing of perianal tears, removal of retained placentas by shoving a fist in. Even C-sections, which were technically laparotomies, where not only bloody but there was also amniotic fluid and often even the newborn's faeces and urine sloshing around everywhere in the surgical field. What made matters worse was that either the mother was awake and under a central nerve block, in which case their nervousness often led to distracting and unnecessary discussions about the progress of the surgery — or, it was an emergency case, and Sherlock was hardly allowed to do anything because time was of the essence.

Only two other students had failed their OSCEs, and they'd failed because they'd been ill on the day. All in all, the gynae&obstetrics course had a reputation of being a rather easy and laid-back course, compared to many other medical school ones. Sherlock had heard his fellow students occasionally comparing how little time they'd allocated to study for their exams as though it was a competition on who was taking the most precarious chance on their academic success. Sometimes the students who claimed not to have studied much got high marks, so they must've been lying. Sherlock can't understand how social currency could be gained by downplaying one's preparations. When his peers sometimes conversationally asked him if he'd prepared well, he answered honestly, and they looked at him as though he'd just arrived from another planet.

At least he's confident that other students don't know he's been assigned these extra hours. Equally baffling to their exam behaviour is how other students' practical shortcomings were treated with collegial support and gentle humour, while Sherlock just got stared at and whispered about when he supposedly did something wrong. One of his year classmates had sewn their glove into a woman's vagina while fixing a tear. Sherlock had heard their fellow students teasing the guy about it playfully, sounding very jovial and forgiving. They never talked about Sherlock in such a tone that signalled fondness and camaraderie.

He yawns now. He hadn't slept a wink since the service had been busy, and he hadn't eaten because anxiety and the foreign smells often decimated his appetite. How was he to remember the existence of food while having to use all his energy and focus on trying to decipher what was expected of him and trying to decide how he could achieve that?

Instead of shadowing the gynae registrars, he'd been told to assist the midwives since that would give him the most interaction with labouring women and their family members. He'd chosen a midwife he knew was an amicable presence — an older one by the name of Maja Prestegard, a Swede who'd worked in the UK for twenty years. She acted maternally and calmly towards the labouring women assigned to her, allowed medical students to participate hands-on, and didn't seem nit-picky about trainees' behaviour.

The first woman out of the three under Maja's care last night had declined students being present — especially male ones. To be precise, the husband had declined them. Based on the surname, Sherlock suspected it was based on cultural beliefs. He certainly didn't wish to be where he wasn't wanted, and Maja took him promptly to the next delivery suit she was in charge of, pausing at the door and turning to address Sherlock before entering.

"Here we have Jenny; she's agreed to medical students. Primigravida, 39+6 weeks, uneventful pregnancy. I've paged the anaesthesia team for an epidural; I hope they can make it here soon. She's nineteen, doesn't have anyone here to support her. She says her mother might be coming here later to keep her company, but she doesn't know if she has received her messages. She doesn't really know who the baby's father is. Jenny's had a tough life, she's been in foster care, lived on the streets and used heroin but has been clean for two years. Her screens were negative for anything but the methadone she is given as replacement therapy. She's quite scared, and I think she could use some company."

Maja then gave Sherlock a pointed smile.

Sherlock had hoped that whoever he was saddled with for the night would not be a first-timer and certainly not someone who would expect him to provide any kind of support beyond assisting the midwife with the technical things.

Maja was about to push the door open, but she then noticed Sherlock was hesitating to step forward. "Ready?"

"But–– what do I _do_?" He had asked, anticipating trouble.

"Just sit with her, hold her hand, answer questions. She's not a big talker."

Jenny turned out to be a thin young woman with turquoise stripes in her messy blonde hair, a few tattoos decorating her shoulders and back. Old track marks adorned the crooks of her elbows, and the sight made similar ones hidden safely underneath Sherlock's long sleeves ache in sympathy. Neither his nor hers were fresh.

"Anaesthesia will be here soon," Maja promised Jenny whose grey eyes, glistening with tears of pain, began tracking the two of them the moment they entered the room. The lighting had been dimmed, and the radio was on, tuned to some inane pop music station.

Jenny nodded, grimacing. "My back hurts," she complained.

"Is it any lower, now?"

Jenny shook her head.

"This is Sherlock. He's a medical student like we talked about? Is that alright?" Maja asked.

"Yeah," Jenny said, obviously disinterested in further conversation as a contraction began on that very moment. She grabbed the laughing gas mask in her thin fingers, gasped into it until the worst of the pain passed.

Instead of the wailing and groaning and screeching Sherlock had had to endure with all the other labours he'd observed, he could appreciate the resigned kind of quiet focus Jenny seemed to have mastered.

Maja passed Sherlock a pair of disposable gloves. "She was four centimetres the last I checked, which is often when we––"

"––request an epidural," Sherlock concluded. "The latent phase pain is often approaching its statistical maxim around that time, and primigravidas may take quite some time after to dilate fully, allowing enough time for the epidural to kick in and be useful. At four centimetres, the labour has made enough progress that the nerve block shouldn't interfere with the birthing process, although the latest literature says it could be done earlier and there would be no statistically significant detrimental effect," Sherlock rattled off. He needed to give Maja a form to fill after the shift was over regarding his performance, and what he lacked in bedside manner he could try to patch up with theoretical knowledge.

"Very good," Maja replied. "Can you now explain that to Jenny as well?"

Jenny had grabbed an emesis bag she was clutching in her shaking fingers; labour often made women nauseous. Judging by the faint smell, the bag was not empty.

Sherlock swallowed. Such things were not pleasant, but long hours at the gastrosurgical operating rooms had helped him acclimatise to encountering bodily fluids. "You're far enough along that an epidural shouldn't interfere with the labour. There's likely still hours to go, and the epidural should make that time more tolerable."

"Okay," Jenny replied, still looking slightly apprehensive. "Does it hurt to put in?"

"Less than what you're currently going through, I'm sure," Sherlock responded, and it seemed to satisfy Jenny, who closed her eyes and took a moment to rest before the next contraction.

Fifteen minutes later, Sherlock was as thankful as Jenny for the arrival of the anaesthesia team. He grabbed a surgical face mask and positioned himself on the opposite side of the bed from where the block was being administered so that he could watch. When the sting of the local anaesthetic began, Jenny struck out a hand, reaching for his, and though Sherlock was not good at reading the emotions of others, the younger woman looked quite pleading. Hesitantly, worried if it was proper and acceptable and wondering how firmly he was supposed to hold on, he took Jenny's hand. It felt a bit warm and sweaty, but at least she wasn't squeezing his fingers to the point of bruising or breaking them.

The epidural helped significantly within twenty minutes: the contractions could still be felt, but they weren't agonisingly, sharply painful anymore. Jenny was even able to take a nap, so Sherlock followed Maja to a neighbouring room to monitor the quick progress of a mother of three — soon to be four. He also got to suture an episiotomy with the gynae registrar on another patient.

After he was directed back to Jenny's room, the next five hours crawled on like a particularly lethargic tortoise. The silence in her birthing suite was thankfully not awkward but amicable; Sherlock was relieved that Jenny truly didn't seem to want to talk about anything. He wasn't sure if he should have attempted to strike up a conversation, but if he wanted to avoid faux pas, it was best to remain silent. Many of the post-birth mothers were full of questions he could never answer. Was their baby normal? Would it be well-behaved and easy, or a colicky handful? How could he know these things? How could anyone know? To Sherlock, much of midwifery wisdom seemed like old wives' tales rather than medical science.

The rest of Jenny's dilation was slow, the pushing phase equally so, and when it was all done, and a smallish male baby was born, Jenny seemed so exhausted she had little interest in the child. She held him after Maja offered to pass him over, but did so slightly reluctantly. No smile spread on her features as the baby opened his eyes and looked at her.

"I don't––" Jenny said, averting her eyes from the baby in her arms. "I don't know––" she began crying, and it was the most dramatic expression of emotion Sherlock had witnessed from her.

He felt apprehensive, like an intruder. _This isn't my job_ , he thought. _This isn't any doctor's job._ That job was done; the baby had been born. What was he supposed to say or do now? All the other women Sherlock had watched give birth had been very tired but also happy at this point. It seemed so… odd, the way Jenny behaved. Should not the hormones of pregnancy cause a biochemical bonding process?

 _Not my responsibility_ , he repeated in his head like a mantra, yes something about her borderline rejection of the child bothered him.

"Do you want to talk to Gemma on Monday, do you think?" Maja asked Jenny.

Sherlock knew that Gemma Moore was the unit's assigned social worker who worked as a liaison with child protective services in cases of vulnerable women, spousal abuse and newborns considered for adoption.

"We'll arrange that," Maja promised Jenny. "But for now, let's just look after this little fella, eh?"

Jenny studied the face of the now slightly squirmy, pink baby boy still covered in vernix, the waxy-looking substance covering babies when they are born. "I guess."

After Sherlock had watched Maja clean the baby, take his measurements, administer vitamin K and wrap the increasingly grumpy infant in some clothes and a blanket, there was a knock on the door, and one of the other midwives poked her head in.

"We've just started an emergency C-section in theatre with shoulder dystocia, and we could use you in there," she told Maja. "Could we swap? I can take over here. How are you doing, sweetheart?" She flashed a quick, rehearsed smile to Jenny, whose lips tightened into something resembling acknowledgement tinged with resentment.

"Of course. Sherlock? If you hurry up, you might be able to scrub in. Mrs Cabrera's on OR duty; she always lets medical students assist."

He definitely wasn't going to protest that he'd been explicitly told not to spend more time in the OR. Besides, he had not seen shoulder dystocia before. A potentially life-threatening complication, it meant that a baby's shoulders were stuck in the birth canal and the help of the most skilled personnel would be needed to resolve the situation.

He should have jumped for joy for the chance to escape the obvious tension in the room, but something made him wonder if it was alright that both of them who had been present for the duration of Jenny's labour would suddenly disappear. Why did he care suddenly? Why _should_ he care? God, he hated obstetrics.

It took him a moment to notice that Jenny was looking at him with bright eyes. She now held the baby a bit closer and was trying to fumblingly replace the knitted hat which was slipping off the baby's bald head. "Thanks, Sherlock," she said, her tone difficult for him to interpret.

Was this an acknowledgement out of courtesy that he'd spent hours attending to her? Was she giving him permission to leave because she could see, plain as day, that he was more interested in the surgery than her?

Or had he really done something right, and she _was_ genuinely thankful?

Such questions thankfully evaporated from his thoughts when he strode into the OR five minutes later after a surgical handwash and a rinse with disinfectant and received a gown and gloves. The rest of the night went quicker; there had been a second C-section, which he also got to assist with since Maja did not call him back into any of the suites. Mrs Cabrera, one of the unit's senior obstetrics consultants, ran a tight ship, barking commands on how to hold retractors and how to suture, and Sherlock was glad for her precise instructions and the chance to practice his instrument skills without having to navigate the minefield of small talk. After spending hours with Jenny, he felt shattered from the strain of keeping up the social scripting even though they had not spoken all that much. It had been nice to end his remedial service with some surgery.

He'll likely never know whether Jenny had thought his presence had actually been helpful. _Surgery outcomes are more obvious._

Before slipping into bed, Sherlock opens the lid of his laptop just long enough to check his email: the only unread one congratulates him on passing his OSCE. With a sigh of relief, he collapses on the bedding. He knows his body is utterly confused, feeling both sleepy and antsy due to his internal clock being out of whack. At least he can look back through the whole course he's just endured and think: _thank God it's over._

Later today, he'll invariably have to endure a phone call from his mother, demanding to know when he'll hop on a train home for Easter. He'd made the mistake of telling her about the remedial practicum; he won't hear the end of it from her over the holidays since it'll just be proof for her that he's made the wrong choice of vocation. Maybe he can get home a few days before the start of the next term to have a breather before his next trial-by-fire: next up will be the compulsory psychiatry and clinical neuroscience course with some primary care practicum thrown into the middle.

_Surely, psychiatry can't be worse than obstetrics?_

  
  


**Notes for the Chapter:**

> Obstetrics is a strange field. It's an adventure of life and death, of family and love but also loneliness and tragedy. It's certainly not a medical specialty which leaves anyone involved emotionally unaffected. The story of Jenny is loosely based on some of J. Baillier's own experiences of a compulsory obstetrics rotation, and the overall descriptions of the field derive from her many years of working as an on-call obstetrics and gynae anaesthetist. 
> 
> In this story, Sherlock will present some rather prejudiced, stubborn and negative views of certain medical and healthcare professionals and their specialisms. Sometimes the reasons behind his thinking are logical in the context of his own history of encountering them, sometimes less so. Let's just say our fledgeling doctor still has a lot to learn about his future profession and about being a respectful team member, and the authors of this story don't share many of his views. That's why medical school and specialty training kind of needs to last for a great number of years — you don't just learn the tricks of the trade; you also grow up. It absolutely is a doctor's job not just to provide medical care but to also be emotionally present and supportive in difficult situations.
> 
> A bit of terminology:  
> – an OSCE means an _objective structured clinical examination_ , a practical course exam consisting of various stations where a student might be asked to perform a procedure, to examine an standardised actor patient or to assess a written account of a patient case, for instance. The student's performance is then graded according to agreed-upon criteria. There's often a separate written theory exam in a big medical school course. Not all medical schools use OSCEs and those that do might not have them in all the big clinical courses.  
> – a laparotomy is an open abdominal operation, as opposed to a laparoscopy which is endoscopic (done through small incisions with the help of a camera)  
> \- primigravida means that it's the first time a woman's been pregnant  
> \- C-section comes from Caesarian section. Yes, it's messy business but it's also great to see a family get to meet their baby for the first time. We just have to firmly tell the dads not to look over the drapes into the surgical field. It's not an urban legend that it's the dads who we sometimes have to catch when they faint.


	2. Out of the frying pan…

"Welcome to the fifth-year placement in Psychiatry and Mental Health, which we hope you will find both stimulating and enjoyable! I'm Doctor Sarah Taylor, and I am the Head of Psychiatry at the Fulbourn Foundation Trust and an Affiliated Lecturer here at the School of Clinical Medicine."

Sherlock slouches down in his seat, in the third row from the back. Easter at home has not lessened his dread for this attachment. As relieved as he is to get rid of obstetrics and gynaecology, psychiatry will be a different sort of beast. He's going to keep his head down, be as inconspicuous as he can, and just get through it, somehow.

 _It's hardly even medicine; mostly just emotional hogwash, isn't it? Psychiatry and neurology used to be one specialty, and that's how it should have stayed._ Basing diagnostics on talking and trying to decipher the emotions of patients instead of properly examining them are the very things likeliest to trip him up in terms of getting a decent mark off the practical placement.  
  
Today's lecturer — the one who's supposed to give them a comprehensive introduction into the field and the course — is a relatively young woman in academic terms, and she's positively oozing with grating, bright-eyed enthusiasm. That is doing nothing to endear Sherlock to what she's saying.

"Psychiatry involves the assessment and treatment of mental disorders. Specialists in the field are medically qualified doctors — and yes, I am one of those — who work within a multidisciplinary team to diagnose and optimise management plans using a holistic, integrated model. We will be learning more about what that actually means as we progress through the attachment."

 _Who's 'we'?_ Sherlock wonders. Maybe he could still hope that this will be the usual tick-boxes-and-collect-signatures kind of course instead of some touchy-feely nonsense. At least Cambridge's academic psychiatry department is world-famous for bridging neurosciences with traditional psychiatry. Much of their research focuses on autism — a topic Sherlock steers clear of.

Doctor Taylor beams a big smile at the students. "Okay, hands up those of you who are interested in psychiatry as a possible career?"

In the lecture hall with nearly two hundred students seated, only about twenty raise their hands. Sherlock presses his sweaty palms onto his knees under the table.

Doctor Taylor's smile turns a little rueful. "Yeah, not so glamorous or gung-ho as, say, cardio-thoracic surgery, is it? But even if you are not thinking of this as a future career, what you learn on this course will make a huge difference in how you succeed or fail in any chosen specialism. The skills you learn here are literally life-changing because so much of what we learn in this placement is about communication — with patients and their families but also with other medical professionals about those patients. And if you think you can just sleep through this course, well, I can assure you that many of your future patients will have co-morbid psychiatric issues that you will have to deal with when you are sorting out their hernias, breast enlargements, heart attacks or gunshot wounds."

She begins scanning the audience, and Sherlock sits up a bit straighter before her gaze moves through his row.

"It makes sense to start at the beginning, to define our role within the healthcare system," she continues, then prods the laptop and another powerpoint slide is projected. "Physicians in somatic specialities examine a patient, provide a medical differential diagnosis, then plan a course of treatment usually consisting of just one line of treatment. Psychiatrists do the same, but our management plans should ideally consist of multiple therapeutic and mental health-enhancing interventions."

She reaches for the laptop again, but her fingers suddenly stop short of the keyboard. "I can see someone in the third row just rolled his eyes. I understand your scepticism; it must all sound rather vague after the rather surgically oriented courses you've had this year."

Someone in the row behind Sherlock sniggers and he sinks further down in the seat and keeps his eyes on his notebook, chastising himself for his involuntary display. This is one attachment where it will not benefit him at all to draw attention to himself.

Too late. Sebastian Wilkes, one of the yearclassmates he likes the least, follows up the snigger with a shout: "Don't mind Holmes, he thinks he's God's gift to neurosurgery. I'm sure he'd prefer to fix all mental illness neatly with a lobotomy."

A warning glare from the lecturer shuts up the heckler, and she proceeds with the next slide which Sherlock thinks is a rather off-putting, cartoonish clipart image of the human brain. "All of you budding neurosurgeons out there might think that the brain is sort of your territory, but I assure you, we psychiatrists got there first. For a long time, traditional neurosciences and psychiatry were a joint specialty; their historical division is once again being bridged back together as we learn more about how genetics and brain chemistry can produce many psychiatric illnesses. Where the history of modern psychiatry begins, ends the reign of attempting to drill demons out of people's heads or employing other inhumane and cruel ways to control what was considered abnormal and undesirable in society."

This sounds acceptable to Sherlock. At least this psychiatrist is not concealing the field's past transgressions done in the name of treatment.

Doctor Taylor continues. "Psychiatry is less about what's going on in any specific area of the brain and more about what is making the patient behave in the way that they are — an integrated view of the sum of their brain functions and the chemical balance therein, if you will. When pathological behaviours and their triggers — some of which we all possess —become something that interferes with the quality of a patient's daily life or endangers them or people close to them, that's when issues turn into diagnosable illnesses. We all have more and less constructive coping mechanisms, for instance, but if a patient never developed a healthy personality structure that would allow them to employ the better ones, then a diagnosis of a personality disorder could be made."

Sherlock still dislikes the idea that a group of doctors are allowed to decide what's pathological when it comes to thinking and behaviour. That means they also get to define what's pathological and insist that patients try to change those things about themselves.

Doctor Taylor reveals the next slide. "In this course, you will hone your skills in taking a history, which will allow you to get the best out of the patients you interview in whatever specialism you'll follow. Above all, the development of a caring and therapeutic relationship between you and your patients means that you have to express respect for their beliefs and values, and this is something that your compulsory psychiatry course can help you with. The communication skills that are needed to pass this course are also essential to create your future patient-doctor -relationships. You must have already learned that most patient complaints stem from miscommunication, not medical malpractice."

There it is, in a nutshell — the reason Sherlock has been most dreading psychiatry is the fact that it depends on communication. He doesn't mind working up the history according to the formulaic model they have been taught; it's merely a case of memorising the checklist of questions and working up the report. _That's easy_. When a patient has a physical ailment, everything tends to be rather factual, and he doesn't need to be able to interpret the emotional content of what is being said to him. Social scripting has got him through the trickier bits in prior courses, and last year's practical exams had only had a few interactions that involved patient communication. The answers a patient gives about physical illness can be correlated with lab tests and imaging, biopsies and procedures, after which Sherlock tends to be confident in being able to come up with a realistic diagnosis and treatment plan. But when there is no wound, no apparent injury, no lab test result, scanned image or physical symptom to be probed, he's lost at sea.

It's _ridiculous._ In Sherlock's experience, patients are usually entirely ignorant of what is wrong with them and are virtually incoherent when it comes to explaining their symptoms in a way that is medically significant. In Sherlock's limited experience with elderly patients with dementia and admissions to A&E of patients with mental health issues, their inability to speak rationally about what it is that is troubling their mind takes his own personal communication challenges to a whole new horrifying level. How could one reach a diagnosis worthy of being called scientific just by interviewing patients? There is also the observation of their external habitus and other nonverbal things, the coherence or lack thereof which they speak, but Sherlock can't pass this course on those alone. Besides, though he can pick up on concrete things but reading between the lines and deducing what patients might be trying to avoid discussing is almost impossible. Relying on communication as the principal diagnostic process for mental disorders is worse than the blind-leading-the-blind; Sherlock knows from experience that it will be fraught with disaster. If he could delete such prior failures from his memory, he would, and he's not looking forward to extending those archives in his Mind Palace. It appears that this placement is going to involve a whole new level of stress.

"Communication… It's at the heart of this attachment," the lecturer repeats once more for emphasis.

Her smile feels threatening to Sherlock, and her statement is like picking at an open wound. He takes a deep breath to calm himself down.

Doctor Taylor prods the laptop, and another slide comes up, so Sherlock swallows his anxiety to resume his note-taking.

"This attachment is designed to give you a better understanding of the different kinds of psychiatry that you will be encountering in your work, and you will each rotate through five different units, including inpatient wards and outpatient clinics. Areas covered will include general psychiatry, child and adolescent psychiatry, as well as old age psychiatry, medical psychotherapy and the neuropsychiatry of learning disabilities and developmental disorders such as autism."

At the last of these, Sherlock's pen stutters on the page, and an involuntary shudder runs through him. By the time he has recovered some semblance of coordination in his writing hand again, the lecturer is plodding on.

"You also need to know something about this hospital, as well as the other mental health units within our Trust and the University Hospital, and I'm not just talking about where the loos are. The Fulbourn has eight inpatient units, and we also manage the PICU ward in Peterborough, as well as the Adult Eating Disorders inpatient unit based at Addenbrookes."

For Sherlock, physical layouts, maps and organisation charts are grounding, and he welcomes the chance to copy such information from the next three slides into his notebook because he knows that if he writes it down, it will become instantly retrievable in his mind. He doesn't have a totally photographic memory, but he has learned how to use kinaesthetic learning techniques to make relevant data readily available — being able to instantly recall facts like these is one of his strengths as a medical student. Flowcharts, mnemonics… concrete data which he can quickly access and reference when being asked a question by a senior.

A new slide comes up, listing more units a student might find themselves placed at, and Taylor does that thing which annoys Sherlock; she reads out exactly what is on the screen. _What is the point of a lecture, if I could just memorise the material quicker in my room?_

"Paediatric Liaison, Criminal Justice Service, Art Therapies, Adult Learning Disabilities, Psychological Wellbeing, Perinatal Mental Health, Personality Disorders, Neurodevelopmental Disorders."

Sherlock's handwriting stalls once again, and he deletes that one from the mental list he is writing down before resuming as she continues.

"Early Intervention and, last but certainly not least, Psychological Medicine."

In his peripheral vision, Sherlock notices a hand go up in the second row, which Doctor Taylor acknowledges, "Yes?"

"Aren't _all_ of the above Psychological Medicine?"

The inquisitive mind belongs to Anwar Patel, whom Sherlock has recognised as a hard-working and very committed student, one who is keen to explore every possible specialism as he tries to decide where to steer his interests after graduation. ' _Anything but pharmacology or anaesthesiology is what my pharmacist parents insist,_ ' he had told Sherlock when they'd been placed together at a gastroenterology ward. The small talk Patel had made that day had been inoffensive and simplistic, and while Sherlock had not exactly welcomed such contact, it had been a pleasant change not to be ignored or mocked.

Doctor Taylor smiles. "Good question. Yes, but in this case, what we are talking about is looking after the mental health of patients who are in hospital for other reasons than their mental health. Physical illness can have profound social and emotional consequences for a patient's mental health. Furthermore, we know that as many as a quarter of general hospital patients have a co-morbid mental health issue, depression being the most prevalent. The risk of depressed patients with coronary heart disease dying in the two years after the initial assessment is twice as high for non-depressed patients. Because specialists in other fields of medicine focus on treating whatever physical ailment troubles their patients, they often fail to recognise or address mental disorders in the same. That's where we come in; we're sort of sniffer dogs for those connections."

Someone laughs, and Doctor Taylor nods emphatically. "Yes, really. A lot of patients who are admitted also have underlying substance abuse issues that may be undetectable on any standard blood tests. A patient who is showing challenging behaviour may simply be suffering from nicotine or prescription drug withdrawal or alcohol dependency. Neuropsychiatric disorders such as ADHD and autism can make it very difficult for a patient to function in a hospital environment and co-operate with staff. So, all of you will learn about the psychiatric assessment of patients in a non-psychiatric unit."

 _Act normal_ , Sherlock tells himself though it's a fool's errand; paranoia and anxiety are now producing physical signs such as making his handwriting shoddier than usual. _None of this concerns me. Nobody knows anything about me._

Taylor looks up at her audience of medical students. "As I've mentioned, one of the core goals of this attachment is to develop your skills in how best to work with your colleagues: how to make a good consult and support your fellow physicians with challenging patient encounters. It's not all about the patient. In Domain Three, the GMC recognises the importance of communication, partnership and teamwork. You will be given some tools here that will help you listen and respond to the concerns and preferences of your colleagues. To achieve this, you will be working in the same small group and in the same pair on a consistent basis, to help you build stronger collegial relationships. There may be more emphasis in this attachment on those aspects than you might be used to from other units, and we've had very good feedback from prior years' groups that they have enjoyed getting to know their fellow students better."

Sherlock can barely stifle a groan. He's loathed by most of the cohort, and the feeling is mutual. The idea of not just being kept in the same group but also being paired up with someone for the whole of the attachment is horrifying.

"To put you all out of your misery, we have already planned your rotations as well as assigned you into groups and pairs. I know nothing about any of you so it is a totally random approach that will prevent good friends from sticking with each other. In this profession, you will almost never have an opportunity to choose with whom you work. So…"

Doctor Taylor passes a stack of papers to the person at the end of each row. Anxious to know who he's going to be stuck with, Sherlock rises from his chair and hastily snatches the stack from the fingers of the student sitting closest to him.

Before he has even sat back down, his eyes rivet to the box that has his name in it, absorbing the five other names. He blinks rapidly as he sees the em dash connecting ' _Holmes_ 'with none other than _'Wilkes_ '. He swallows, trying to process how it is possible that not only has he ended up in the same subgroup of thirty students but that he's also been _paired_ with the one person in the cohort whom he cannot abide with a passion that is verging on homicidal. Wilkes is an obnoxious, egotistical bully who's had it in for Sherlock right from the start of medical school. He seems to derive the same kind of gleeful enjoyment out of his discomfort as others of his ilk have during Sherlock's school years. He'd hoped that medical school would have provided a more civil environment, but alas, the entrance criteria obviously fail to discard the applications of malignant idiots.

His and Wilkes' personal animosity had begun during the very first weeks of first year's anatomy lab. Wilkes, with obviously no raw talent at all for surgical procedures, had done a butcher's job of dissecting the right brachial plexus. To prevent the enthusiastic and clueless boy from ruining the left as well before anyone could learn the details of the structure, Sherlock had involved their instructor who had banished Wilkes from holding the scalpel. Sherlock had been itching to take over, but the other students in the group had seemed fit to punish him for breaking ranks by making sure he mostly just got to watch. Thankfully, he had managed to pilfer a janitor key to the anatomy department, enabling him to conduct his own learning sessions with the cadaver in the evening. From then on, Wilkes had done his best to turn the other students in his social circle of pretentious, rich blowhards against Sherlock.

All he wanted was to graduate and to be left alone until them.

"Do you mind?" The student sitting to his right in the same row snaps.

Sherlock realises he has been inadvertently hogging the rest of the lists. He gives the rest to her, dropping his own copy in the process. He realises a few seconds later, back in his seat with the list clutched in his hand, that he is verging on hyperventilating. If he does not do something physical to break the rising tide of nervous energy, he will go into a panic attack or worse. He slaps his notebook closed, shoves it and the pen into his backpack at his feet, using it as an opportunity to put his head down between his knees to take a number of deep breaths, slowing down his respiration rate.

There is a female voice speaking in the distance, sounding as though they're all in a tunnel: "These groups will each be managed by one of the senior registrars in the clinical service you're rotating through; they will be responsible for supervising your group and pair work. They will be contacting you this afternoon with your first rota schedules and arranging group meeting times."

Sherlock pretends he's just been looking for a pen and drags himself back up into a sitting position long enough to find the name of the Senior Registrar who will be looking after his group: Charlotte Standish. He slumps down into a slouched position and closes his eyes. He doesn't know any of the psychiatry teaching staff, and it wouldn't make a very good first impression if he approached them to ask to be assigned a different partner. They'd probably just lecture him about interpersonal skills and communication.

"Finally, I want to draw your attention to this last slide," Doctor Taylor says.

Because it might well be important, Sherlock opens his eyes to read the title: ' _Clinical Student Mental Health Service_ '. Hecloses his eyes again, drops his head and starts counting his breaths.

Taylor explains: "This is something that Fulbourn also provides to complement GP services and counselling offered by the University. What we're about is ensuring the pastoral support of medical students and trainee doctors in a way that takes into account the special nature of the things you encounter during this phase of your studies. No one is going to pretend that this profession is not stressful, and this course offers a context for talking about our stress management skills and mental wellbeing. If we cannot take care of ourselves, then we are endangering our patients and our colleagues. There are contact names here; you can also be referred to this service by the GP you're registered with."

Sherlock very nearly scoffs. _As if I'd ever talk to a GP even if I did have a need for such nonsense._ If there is a specialism that he dislikes more than psychiatry, it is general practice. An old motto — _jack of all trades, master of none —_ comes to mind. Primary care is something he loathes, not only on a professional level but on a more visceral basis, having been a consumer of its services as dragged to countless appointments by his mother.

All students at Cambridge University are registered with a GP. Trinity favours the Bridge Street practice; logical, since it is close to the college. Mostly because his parents had insisted, Sherlock did go through the process of filling out the registration form. That said, he's never crossed the threshold of the place thereafter and never intends to do so again because he has no intention of being anybody's patient. Violet Holmes had subjected him to more than enough of that, and other torturous interventions in his childhood. She had wanted to help him fill the forms — help which he had sternly declined. She would have put things there which nobody in Cambridge had any business knowing. Sherlock's entire career at medical school so far has been based on putting such things behind him, not letting them define him.

No one here knows anything about his past medical history, and that is the way he intends to keep it. He's suddenly filled with an irrepressible desire to flee the room. _Only four minutes left._

Doctor Taylor is still talking as he is reaching for his jacket that he'd stuffed under the seat. "It's such an important point that I want to make it absolutely clear. You must not underestimate the emotional toll that this attachment is going to exact from you. People with mental health challenges can be unsettling, emotionally draining and difficult to manage, and for some of you, memories of personal experiences may surface. It’s okay to admit that this placement can sometimes exhaust you. Being able to empathise with psychiatric patients is an important part of being a physician, but it takes time to construct a protective professional role to protect us from diving in too deep. Just remember that those difficult, unsettling, emotionally draining individuals who need psychiatric services are often frustrated because they tend to be forgot in the bowels of the system. They deserve your support and compassion."

Her tone of voice softens as she continues. "And it applies to all of you, too. The stigma attached to being honest about one's mental health afflicts the medical profession even worse than the patients we serve, and it cannot be allowed to continue like this. If you aspire to be a physician, then you do not have to pretend that you are always fine or to think you have to heal yourself. There is no shame in admitting that you need support and help. That's what we are here for."

Sherlock's shoulders his jacket while still seated, watching the clock on the wall of the lecture room click to the time when the class should have ended.

Oblivious of the time, Doctor Taylor is still speaking. "If we cannot be compassionate with ourselves if we try to ignore our own mental health and show no understanding of our colleagues in their times of need, then how can we hold ourselves out as being caring doctors? I hope that this unit will also teach you all how to be honest about how you are feeling, how you are coping with stress on a personal level, and how to learn coping strategies both as an individual and as colleagues. Above all else, it will require you to be honest with yourself and with others."

 _This, just this._ Though he has not been able to verbalise it in his head, it's suddenly clear that this is the most pressing reason why Sherlock fears this attachment. Honesty risks exposing him to the ridicule, the prejudices and the disgust of his peers and the doctors; it undermines everything that he has achieved so far and jeopardises his future. His survival of medical school depends on being able to keep others at bay, to keep to himself, to carefully curate what he shares about his life.

No longer able to endure sitting still, Sherlock gathers his stuff and stands up, moving to his left, stepping over the legs of the other students, who grumble at his clumsy departure.

It takes him almost ten minutes of standing outside, chain-smoking three cigarettes before his heart rate has calmed to the point where he can return to the building to await the start of the next lecture.

**Notes for the Chapter:**

> Incidentally, the medical school J. Baillier attended also featured both the surgical main courses and the psychiatry course within the same year. Quite a whiplash.
> 
> What the lecturer says about the particular stigma of mental illness in medical students and physicians remains a sad fact. Things are slowly changing for the better, but the internalised horror of admitting to such a thing and the fear of being considered unfit for one's profession by colleagues can be so paralysing that it can easily prevent people from getting help. The statistics of physician suicides especially among young doctors is a most alarming tragedy. In one study, half of female physicians who fulfilled the criteria for a mental health issue did not seek treatment for fears of professional repercussions. According to [a study done by the British Medical Association in 2019](https://archive.bma.org.uk/news/media-centre/press-releases/2019/may/serious-mental-health-crisis-among-doctors-and-medical-students-revealed-in-bma-report), a staggering 80 % of physicians were at a severe risk of burnout, with junior colleagues most at risk. In that study, it shone through clearly that a major hurdle to treatment was that physicians themselves saw mental illness as a sign of weakness.
> 
> Anyone interested in the topic should check out Caroline Elton's book _Also Human_. Elton is a British psychologist whose career has focused on helping doctors and medical students.
> 
> Here's [a link to the Differential Diagnosis tag of J's Tumblr](https://jbaillier.tumblr.com/tagged/diffdg), which will feature visuals for all or most chapters, including these:
> 
>   
> 


	3. The Human Knot

As Sherlock walks into the group teaching room at Addenbrooke's, he has to stifle a flare of anxiety. The room set up is signalling something different from what he is used to — gone is the boardroom table, the chairs are arranged in a circle. _No place to hide._ Without the physical barrier of a table or an individual desk attached to the chair, there will be nowhere to put a notebook, no way to easily keep his eyes down on the ruled paper, no way to maintain the appearance of being actively engaged with the content without having to make eye contact, no way to stim inconspicuously.

Until now, he'd not appreciated how the psychiatry course's first Practical Clinical Skills session could be even more of an ordeal than usual. It's bad enough that he has to do small group work which he loathes but, to top it all, he is going to have to deal with Wilkes in a session that appears to involve activities he can't predict and prepare for. _Should have known,_ he thinks, _judging by all that talk by the Lecturer about teamwork and relationship-building_.

"Take a seat, everyone."

The Clinical Lecturer who issues this invitation is a woman in her mid-thirties with large, silvery hoop earrings which catch the light in a distracting manner as she moves.

Sherlock walks to the chair furthest from the door, where the wall is about two feet behind. He drops his book bag on the floor and retrieves his notebook and pen, using his thigh as an impromptu desk. The only free seat is next to Wilkes, who ignores him as he shoves his book bag under the seat.

They are seven in total in this session, and Sherlock is pleased that Anwar Patel is one of them. He's talking to David Wright, a rugby enthusiast from Pembroke College who aspires to be either an orthopaedist or a specialist in elite sports medicine. Arabella Stevens is one of those blonde, blue-eyed girls who seem to actively try to hide the fact that she's clever, especially when flirting with the boys. Sherlock's not sure about her; her intelligence might win out if she can get past the partying phase that seems to have suck in so many of the girls at Gonville & Caius. Though it is one of the oldest colleges at Cambridge, it rarely takes in many medical students, if any.

Wilkes ignores him in lieu of eying up the other girl in the group — Tasha Caines. She's lithe, dark-haired, always conservatively dressed, serious and very, very hard-working — a St Catharine's College student who has shown a real knack for effortlessly mastering such complex processes as endocrinological feedback loops. She is aiming for a PhD on the side, and Sherlock respects her research skills and her commitment to learning. He's not even sure she knows who he is; they haven't been placed in the same group before. She has always seemed aloof but courteous; a combination Sherlock can deal with. The hardest crowd for him to get along with are the party people such as Wilkes and the crowd with which he spends his free time.

As soon as Sherlock is in his chair, the Lecturer begins.

"Hi, everyone. I'm Sandra Gidleigh, and I'm the lucky one to be running three of your practical clinical skills sessions during this attachment. As you've already been told by the course director, you'll be working in this group, and in your assigned pair, for the rest of the term." 

As she looks around the circle, Sherlock can see through his peripheral vision that her gaze has stopped on him. "There is a reason why the chairs are set in this way, so you can all put your notebooks away."

Aware that he's the only one with such an item out, Sherlock almost flinches. He quickly complies, keeping his eyes averted.

Gidleigh continues. "This attachment puts more significance on communication than perhaps any other you will have taken so far. That includes listening skills, which is why I am going to ask you _not_ to take notes during the sessions. If your patient feels like you are only focused on your paperwork, it will be detrimental to the success of your interview. You need to hone your abilities to encourage people to talk, to take in information you hear, process it and act on it."

Sherlock notices Wilkes quickly pulling out a mobile phone from his pocket, glancing at it and then shoving back into his bag. _So much for appearing interested_.

"Which brings us to the first skill you need to master: taking a psychiatric history," Gidleigh declares. "We can skip through the kinds of physical health-related questions you've already used in previous attachments. I'm not saying that they aren't important; they are, but I am hoping that it's nothing new for you to deal with the standard questions about past somatic history, medications and so on. In psychiatry, the patient's _life_ history is more important: where did they grow up, what was their childhood like, what stress factors are there in their lives and what kinds of coping mechanisms have they learned?"

Sherlock accidentally drops the pen he's been twirling in his fingers. Wilkes picks it up for him with a sardonic raise of his brow.

"Thank you," Sherlock mutters, and shoves it in his bag.

"Today, we are going to focus on learning to listen to the patient's narrative and assessing the level of integration in their answers between attention, memory, emotional responses, intellectual self-analysis, sense of a timeline as well as their attitudes towards important other individuals in their lives. Moving the focus back and forward, towards more intimate issues and then back to safer ground is an important interview skill. You may experiment on that. Practising such things is also a chance to get to know your pair buddy. And remember, patient confidentiality should extend to your pair as well. What is discussed here today, shall remain here," the teacher — whose name Sherlock has already forgot in his rising anxiety — instructs.

"Pair up, and let's get started. You each get a copy of this," Gidleigh says, pulling out a stack of handouts from her bag.

Chairs are dragged around, seats changed, and before long, Sherlock is sitting face-to-face with Sebastian Wilkes, who grins and says, "Hello, _buddy."_

He is leaning confidently back in his seat, watching Sherlock with his signature knowing smile that wraps his thin lips tight around his front teeth. Sherlock thinks it's more of a banker's or lawyer's smirk than one to put a patient at ease. The proportions of his face disturb Sherlock; he really cannot see what the young women who seem to flock around Wilkes see.

It's not the first time they're practising skills on each other as medical students. Starting IVs, even doing a nerve block for a sinus lavage by sticking cotton-ended sticks wet with lidocaine had been first performed on course-mates before real patients. Neurological exams, auscultation of the heart and lungs and using basic diagnostic instruments such as an ophthalmoscope and an otoscope were also among things first practised on other students. The auscultation session had not been any fun at all; those boys who prided themselves in muscles they had forged at the local gyms and tans they'd amassed on holidays wasted no time in discarding their shirts and volunteering as study subjects for the girls in the group. Nudity had never bothered Sherlock, but in that company, he had felt terribly out of place. He knew he was lanky, skinny and pale compared to those other males' physiques which were much closer to traditional ideals. He got stared at and judged enough without even taking his shirt off.

Wilkes had been in his group then, too. He'd snickered when one of the rugby players in the group had teased Sherlock by asking if he liked what he was seeing. As usual, he hadn't realised he'd been staring at what he'd been analysing for too long. There had been an uneven number of students in the group that day which had made things doubly awkward; in the end, their Clinical Lecturer had assigned him as a third wheel to a pair of girls. At least they'd been civil with him.

Sherlock is startled out of his thoughts when Wilkes speaks up.

"Earth to Holmes," he jokes. "We should get started. While you've been daydreaming, I've read the first two pages," Wilkes wafts the three-page leaflet they've been given.

Sherlock hastily opens his own and does the same. The handout contains a structural model of a psychiatric interview, and a list of observation questions to be filled in once they've interviewed each other.

"So, _what brings you here today,_ Sherlock?" Wilkes mockingly quotes the suggested opening line on the first page.

Sherlock gives him a look. "You want to take turns, or go through all of it at once?"

"Not much of a proper interview if we just take turns, is it?" Wilkes seems carefree, not put off at all by what they're doing.

Sherlock is envious of this, and that annoys him, so he snaps. "Proceed, then."

"Date of birth?"

"January sixth, 1979."

"Oh. Big parties on the day, then?" Wilkes' tone seems to signal that he assumes the opposite.

"Yes." Sherlock looks at the floor. In fact, Sherlock had not celebrated the day much at all, but that's none of Wilkes' business. He'd returned to Cambridge two days prior to avoid his mother's fussing and having to decline the over-iced, dry cake she always baked for family celebrations. She had pushed a wrapped present into his arms just as he was leaving for the train, and he now realises it still sits unopened under a pile of clothes on the floor of his room.

"Medications, chronic health issues?"

"No." Sherlock detests the word 'chronic'. It reeks of the unavoidable, the sentence of a lifelong developmental disorder or congenital defect.

"Born full term?"

He realises he doesn't know. He's never asked. If he had been significantly premature, he's fairly confident that Violet Holmes would have lamented about that fact to him while complaining about all the other ways in which he's failed to meet her expectations of how one is supposed to conduct oneself. In contrast, she never failed to inform people how Mycroft had been the _perfect little angel_ as a child, _so clever and well-behaved_.

"Probably," Sherlock settles for with a shrug.

"Any developmental deviations?"

The question makes Sherlock blink fiercely. As if he would admit something like that, just come out and announce it. He knows full well the precise expression on the handout is the more polite _'delays in achieving developmental milestones_ '.

He opts for deflection, based on a purposeful misuse of the word. " _'Deviations_ '? Sounds like you're trying to suss out whether I was a juvenile delinquent."

Wilkes smirks. "Well, were you?"

"Hardly." Again, his mother would probably disagree, due to the fact that he'd once left home without telling anyone and moved to London to be with Victor and they both used during that time. _Oh, how Wilkes would rejoice at hearing such things._

"Any living family?"

"Parents are both alive, living in Sussex. One older brother."

"Parents' professions?"

"My mother is a professor of economics at Imperial, and my father is a biochemist-turned-businessman."

"Good relationships with them?"

 _What does 'good' even mean?_ He tolerates them, and they pretend to love him. "My brother lives in Switzerland. My parents are… parents." He shrugs. "I went home for Christmas."

Wilkes looks nonplussed. "Where did you go to school?"

Sherlock gives the name of the village they lived in back then. He's _not_ telling Wilkes he was taught at home for years before being sent to boarding school, nor will he indulge Wilkes' desire to play class games about minor public schools. "Then Harrow," he adds defiantly. That should be impressive enough.

"You said you were born in 1979, yet here you are with a cohort that's a year younger. What happened? Fail your first attempt at A levels?" Wilkes asks next.

Sherlock will not give him the satisfaction of learning the truth. "I took a gap year after sixth form. Travelled." Isn't that what the heirs of poncey new money like Wilkes' family might do?

"Where?"

 _Damn._ "Here and there."

"Sounds so exciting," Wilkes drawls with a malignant smirk, then consults the handout again. "What was discipline like at home?"

"I don't know what that means."

"I suppose they're trying to suss out physical punishment, child abuse, that sort of thing?"

"Nothing out of the ordinary," Sherlock stammers. Violet and George Holmes never spanked their children, and while Sherlock would have certainly hoped for his mother to be much more lenient about her expectations of his behaviour, he doesn't want to discuss this with Wilkes any more than he wants to open up about any other aspect of his childhood.

He glances around and sees the rest of the group engaged in lively, amicable discussions with relaxed smiles on their face. He seems to be the only one currently on high alert and defensive.

Wilkes presses on. "Anyone in your family with mental health issues?"

"Not as far as I know."

"So, you're saying that the bunch of people that produced _you_ are entirely bloody normal, then? How's that work?" Wilkes chuckles. "Oh, I think I forgot one of the earlier questions: _has anyone offered you a psychiatric diagnosis before?_ "

" _No_ ," Sherlock replies pointedly, spitting the syllable out between his teeth. Perhaps his annoyed tone will disguise the blatant lie.

Wilkes pretends to cross over that question with an exaggerated flourish. "No medications, then, I assume. No past psychotherapy. Nothing wonky whatsoever," he declares.

Even Sherlock can tell he's being sarcastic. He bites his lip but raises his chin to shake his head.

"Do you use alcohol?"

"Not if I can avoid it."

"Life of the party, our Holmes. Drugs?"

"No." Though he knows full well that both his cardigan and his dress shirt are covering the scars on the crooks of his arms, he has to force his eyes to stay away from those spots. In theatre, he always wears scrubs a size bigger than he should be so that the sleeves are long enough to cover them, and slips a long-sleeved T-shirt underneath whenever he can get away with it.

"Smoke?"

"Yes."

"Ah, so you admit to an imperfection. You smoke like a veritable chimney, if the aroma in your jacket is anything to go by," Wilkes comments as he notes down this fact as if he'd just won a prize.

"Oh, this is a good one," Wilkes' finger — _slightly swollen due to last night's alcohol consumption and inadequate hydration, as also evidenced by the puffiness around his eyes_ , Sherlock's brain uselessly supplies him — is tracing a sentence in the handout. "Any unwanted sexual advances, ever?"

Sherlock checks the handout to see if such a question really exists, and unfortunately, it does. It follows the one about discipline at home. _Fishing for past abusive, traumatic experiences_. _Logical._ "No," he says, and for once, he can be honest. At least he thinks so. When he'd been with Victor, there had been… interest, sometimes, from some of the people Victor knew from dealing, but no one had ever tried to assault him. They'd taken no for an answer, and Victor had usually been there to watch over him.

Wilkes snorts. "Any deaths in the family?"

"My maternal grandparents, but I was very young. My father's parents died before I was born."

"Do you have friends or family members living close by?" Wilkes reads out loud.

"No."

"You're King's, aren't you?" Wilkes asks, referring to Sherlock's constituent college. "Living at Keynes?"

"Yes." What is Wilkes getting at?

"Tasha's King's, too. She says she's never seen you in any of the common areas. Neither have I when I visit her there."

 _That's because I avoid those places if I can._ "What's it to you?"

"I thought we were supposed to get to know each other," Wilkes says with exaggerated disappointment. Then he shrugs. "I think that's about it. I'll just fill out this observation part, then. _Personal hygiene_ : neurotically flawless. _Mannerisms_ : rolls eyes. _Abnormal movements_ : can't sit still and fidgets all the time, _Posture and gait_ : stiff like a corpse, as usual. _Eye contact_ : avoids like the plague. _Coherence:_ Lord knows; well, you're not drunk, so I suppose you are coherent. _Verbal output_ : monosyllabic. _Mood_ : chronically harried."

Sherlock forces himself to meet Wilkes' gaze. "My turn, then."

The answers he gets as he dutifully trudges through the handout's questions confirm what he either already knew or suspected about Wilkes. The son of an investment banker and a stay-at-home mum, Sebastian is the only child and utterly spoiled as a result; ' _no family discipline_ ', as the young man proudly jokes. According to Wilkes, his well-adjusted and mentally sound primary family live in a posh part of London; he sees them frequently, and Sherlock suspects this is mostly to have a place to stay while he builds his network of social contacts.

"One can never know how many might become private clients one day," Wilkes boasts.

"Have you a specialty in mind?" Sherlock asks, genuinely curious even though the last thing he wants is to prolong their conversation.

Wilkes crosses his fingers behind his neck. "I've been thinking of Derm. Plenty of private patients, no late nights on call, quick consults."

Sherlock doesn't even attempt to hide his disdain. Students tend to joke that all dermatologists do is prescribe cortisone creams. There is something to be said in defence of a specialty where the ability to memorise and employ visual data of common presentations is the core of diagnostics instead of relying too much on lab work and imaging, but Sherlock would still imagine just focusing on skin diseases as dull as being GP, if less stressful. _Sebastian Wilkes, the future smarmy Derm to the idle nouveau riche of London. Good luck with that._

He learns that Wilkes went to Eton, which explains his slightly sneering reaction to Sherlock having attended Harrow. The traditional school rivalry adds grist to the mill of their friction.

"Eton's where I learned how to party like a pro," Sebastian announces.

The question about unwanted sexual advances gets Sherlock a laugh: "Not in my direction; some of my conquests have commented on my persistence, but I am nothing if not a gentleman at heart, and there have been no next-morning complains."

Gentleman is not a word that comes to mind; Sherlock has observed what the boy describes as _persistence_ in action. The girls in their class don't always seem to welcome it.

Sherlock could have filled out the next parts of the questionnaire without even asking questions about alcohol and drugs out loud. He thinks it likely that Wilkes has dabbled with at least party drugs like marijuana and ecstasy.

A summary of Sherlock's observations is delivered in staccato: "You spend money on expensive label clothes but don't keep them maintained; the missing button and stain of last night's coffee consumed in quantity to compensate for the lethargy of a descending blood alcohol level shows you are missing the services of your mother or perhaps even house staff. Personal hygiene: passable; you have not showered since the party last night since you knew there would be no exposure to patients today. Your mannerisms are designed to impress others, indulging in physical contact with females that borders on suggestive. No abnormal movements, unless one counts your propensity to take up more physical space than is polite or necessary. With males, your posture and gait are designed to impress them that you are _'one of the lads_ '. Mood: upbeat, even _chronically carefree_. Coherence: normal. Eye contact is direct and designed either to intimidate or to impress. Have I left anything out?"

Sebastian is laughing by the end of it. "Nope. You've got me to a T," he replies proudly.  
  
  


______________________

  
  
  
Sandra Gidleigh calls them back to order once all pairs have finished the exercise.

"That little one-to-one should have introduced you to some of the more intimate questions that come up in a psychological patient history. It isn't easy, is it — either asking or answering questions about unwanted sexual contact, childhood, drug and alcohol use or personal experiences with death and family-administered discipline. You need to give your patient space and time to approach those difficult topics in their own way. Research has shown that the average doctor interrupts their patient after just eleven seconds."

 _Because patients ramble on about irrelevant nonsense and never get to the point otherwise_ , Sherlock thinks. Since both he and Wilkes knew what they were after — what the purpose of the questions was — they could provide concise, to-the-point answers. They won't have that luxury with real patients.

Gidleigh continues: "Listening also involves tone of voice, and you need to be able to assess that tone in the context of the patient's mental state. Indicators of stress can involve non-verbal things like body language. Observation requires a higher degree of emotional intelligence on your part. What is the patient _not_ saying? To what degree should you as a clinician believe what you are hearing? Many patients find being honest and truthful about their emotional well-being, their state of mind, if you prefer, to be very, very hard. Admitting to a diagnosis or symptoms to which society attaches a stigma is not easy, and many fear repercussions to the careers, their friendships or their family life."

Sherlock can certainly understand why.

Gidleigh perches on the edge of the desk at the front of the room. "So, one of the key elements of your clinical work is establishing a rapport with your patient so that the communication you share is both truthful and sensitive to the emotional issues at stake. To do that well, you need to learn how to foster trust. How will you encourage your patient to open up to you, if you struggle to coax forth that effect from your peers? Many of the exercises we will do in these sessions will be in pairs and may involve roleplaying. Take time to get to know your pair outside of the classroom and the clinical setting. Find out what makes him or her tick as a person. Once you are able to see them outside of their usual role as a medical student, you can then transfer the ability to seeing your patients as more than just the objects of medical scrutiny."

The thought of spending any time at all with Sebastian Wilkes makes Sherlock nauseous, but at least in a clinical or academic setting, he has some protection. The idea of the boy getting to know Sherlock any better is terrifying; he's certain that anything Wilkes picks up can and will be used against him.

"Another thing we'll be focusing on besides the theory of psychiatry is teamwork. You will almost never work as a sole practitioner in the medical world, so teamwork and building rapport with your colleagues and other healthcare professionals are crucial. That's why we're going to run some trust-building team exercises in each clinical skills lab session."

Gidleigh stands up and moves her chair back up against the wall. "Everyone up, and let's get these chairs out of the way."

Amidst the clatter and bang of the others doing this, Sherlock struggles to grab his book bag and the jacket he'd carefully draped across the back of the chair to stop it from getting creased. When he's done shifting his chair away and turns back to face the rest of the group, he sees that they are looking at him, waiting. Suddenly self-conscious, Sherlock's steps halt as he tries to deduce what he's expected to do. _They're all just standing there. Have I missed hearing the first instructions?_

Gidleigh flashes him a reassuring smile. "Let’s have some fun. We're going to do something called the Human Knot exercise. I want you to form a circle, facing inwards."

Once they are in position, she instructs further. "Okay, raise your right hand up high and toward the centre. Now reach across to the person opposite you or nearly so and clasp hands."

Everyone has to shuffle in a bit closer to be able to reach that far. Sherlock stiffens as David Wright takes advantage of his height to reach across the centre and snag his hand. The physical contact is sudden, awkward and uncomfortable; the rugby player's hand is enormous and swallows Sherlock's more slender one in a bone-creakingly tight grip. The others in the circle are following suit; Sherlock is not surprised to see that Sebastian has picked up Arabella's hand with its immaculately manicured fingers — _clearly in breach of hospital hygiene rules about nail length and polish_. Wilkes kisses the back of it theatrically, making the girl giggle.

Gidleigh orders, "Now, take your left hand and find another person across from you to hold onto; anyone will do except the person on your immediate right or left."

Sherlock is the last to comply and ends up holding Tasha Caines'. The resulting knot of clasped hands in the middle looks like some giant tarantula. To bridge the gap between the sides of the circle, everyone has had to move closer. Sherlock's shoulders are now touching those of Anwar and Arabella, and he is finding it increasingly hard to breathe. The whole thing feels like walls closing in on him.

The Lecturer now announces, "You have ten minutes to work out how to unravel yourselves in a way that leaves you still holding hands with the people next to you, but in a simple circle. You cannot let go of anyone's hands in the process. Getting from where you are now to the finish is going to require teamwork and good communication. The clock starts… now."

Relief floods through Sherlock; if he excels at something, it's solving puzzles. The faster he can work this out, the faster he can retreat from this human sandwich that's making his skin crawl.

Wilkes punctuates the expectant, nervous laughter bubbling up within the group with a quip, "Who says I ever want to let go of your hand, Bella?"

Sherlock resolutely ignores him and starts surveying the tangle of hands and the position of the people to whom they belong. As a few of the others test various moves and giggle, he calculates the manoeuvres needed and the order in which they must be done. _It's quite simple, really._

"What if we…" Anwar starts suggesting somewhere behind him, "…um, David, can you step over Tasha and Sherlock's hands, then we can…"

David follows suit, and they end up tangled even tighter together.

"Go back," Sherlock commands. "Anwar, you need to cross over Sebastian and Arabella's, instead, and after––"

"No point in going back, is there," David dismisses. "There's got to be like at least five ways to solve this."

"Two," Sherlock corrects, "and neither of them––" he trails off when he spots several people stepping back to lift their feet over clasped hands. _That's not right at all! Why don't people ever stop to think before they make a mess?_

"M'lady," Sebastian tells Arabella and lowers their hands so that she can shift closer to Anwar and Tasha, jostling her and Sherlock a bit in the process.

"Sebastian, _stop_!" Sherlock commands, "You're making it worse!" He then launches into an explanation of how they should be solving the problem and could potentially do so with at least four minutes to spare. His list of moves is met with blank stares and an eye roll from Wilkes.

"You expect us to remember all that?" Anwar asks, incredulously. "I'm pretty sure if I just go under here––" he tries to limbo himself underneath two sets of joined hands.

"Oh, for heaven's sake!" Sherlock curses, takes three steps to the side and starts shoving Patel back so that he can then direct him to step over David and Arabella's joined hands, instead.

"You weren't supposed to let go," Tasha says dryly. "Technically, that means we've lost."

Sherlock inhales, realising she's right. He had just been trying to solve the problem and forgot himself in the process.

"It's alright," the Lecturer has appeared at his side. "Just retake your position, and you can all continue."

With the rest of the group glaring at him, Sherlock reluctantly grabs David's sweaty and Tasha's faintly lavender-scented hand that has a slight film of oily hand lotion residue. To his relief, she remembers at least some of what he had explained. Working together, the two of them manage to instruct the rest of the group in how to untangle themselves.

"Well done," the Lecturer tells them. "That was… illuminating. Now, what can we learn about how each of you approached the problem and functioned within the group? Did you contribute to the group effort or go solo, and how did that work out for you?"

Sherlock takes his old seat at the back and avoids looking at anyone. Their instructor's questions point to there being a wrong and a right way to do this, and he now doubts that he had chosen the correct one. Why couldn't Gidleigh have told them beforehand that results wouldn't matter much in her assessment?

The other students exchange some platitudes about Anwar's imaginative suggestions and Sebastian's chivalrous politeness.

Nobody says anything about Sherlock until Tasha speaks up in a no-nonsense tone. "Sherlock was right about the logic of the thing, but there was no way for the rest of us to know that at first."

"He didn't bother to explain it in a way that would have made sense," Arabella pipes in.

"Story of his life, I'll bet," Sebastian says, and David chuckles a little.

Their instructor's brows knit together. "That all goes to show how difficult working as a group can be. Listening to each other — or not, as you've just proven — is crucial. As is respect for one another, which I am sensing could be in better supply. It's clearly something that you all need to work on. Every group needs a leader, and leadership is either assigned or earned. Even assigned leaders, such as the lead consultant of a multidisciplinary team, must earn the respect and trust of his or her team members to build a good working environment. In psychiatric group meetings, it is the job of the team leader to convince the patient that they will receive skilled help from a coherent group where everyone is working for their benefit. There is leadership training available for physicians, including specialty trainees, which I highly recommend."

Sherlock glances at the wall clock. There are still fifteen minutes left before the session ends. He's itching to readjust the clothing that had shifted in the course of the ridiculous exercise and is desperate to wash his hands. When working with patients, he prefers using gloves — as long as they're not powdered inside. After removing a pair, the dry residue makes him feel like he's listening to someone scratching nails down a backboard.

The Lecturer takes a breath and glances at the clock as well. "Right, we only have time left for a quick canter past the three assessments for your clinical attachment. It's important that you get your head around this now, as the rotation starts. Assessment in the course is in common with other units: a mix of an exam, mini-practicals done on the same day as the theory exam and the portfolio. You will also be given a written statement about your performance in the clinical placements by the doctors supervising your work. So, in theory, nothing you haven't gone through before."

Sherlock finds his fingers itching to have a pen in them and his notebook open. If he can do something with his hands, he might be able to push the past fifteen minutes to the back of his mind and focus.

Their instructor continues. "However, portfolio work will be different in this attachment. Yes, you have three patients to write up, complete with your initial differential diagnosis, treatment plan and the follow-up. What is different is that one of the three portfolio patients must be identical for the whole of this study group and will be selected from the patients on the teaching rounds you'll all attend together next week. In next week's session, I will give you more detailed instructions on this project. The second portfolio entry is designed to be based on one of the patients with whom you have interacted while on your different placements. Your choice; no comparison's possible, as every patient is different. The third portfolio patient is also one of your own choice, but in this instance, the case should be based on a patient you have encountered _outside_ this attachment. The aim is to reflect your skills at dealing with psychological issues in a somatic medical setting. You are all doing other courses this term alongside this unit, so find me a good case and strut your stuff."

Sherlock's processing of her speech stutters over the phrase. What does _strut your stuff_ mean in the context of a patient case study? Is there some hidden meaning here? He writes the phrase down in the margin of his notes, with an asterisk and the scrawled word 'RESEARCH' next to it.

Finally, the session ends. Relieved, he hurries out of the room, only to hear his name being called out by Wilkes. _What now? Has he been sitting on a fresh insult all this time, and can't wait to share it?_

"The course plan says we have to be in Peterborough tomorrow at eight. You haven't got a car, have you? Would spare us a few minutes in the morning."

"No, I don't."

Sherlock doesn't even have a driver's licence; his mother had declared the notion absurd that he could manage alone in traffic. She still calls him every time he's due to come home for the holidays to instruct him how to get on the right train — as though he hasn't managed perfectly well with public transport since he was a teenager. _It's not rocket science_.

In all honesty, he would very much prefer a car to the heaving rush hour masses in buses and trains.

"Right. Train it is, then," Wilkes concludes and pivots on his heel, leaving Sherlock staring at his receding back.

He heads outside and opens a new pack of cigarettes. There should be enough time between now and his next class to try to get his nerves back under control.


	4. Theory Into Practice

After taking a short, early morning train trip from Cambridge, Sherlock and Sebastian walk from the Peterborough train station to Beech House, the location of the Peterborough and Borders Adult Locality Team. They're here for their assigned attachment in acute adult outpatient psychiatry. The Locality Team assesses and plans treatment mostly for adults with little or no prior history of mental illness; there is a separate team handling acute-on-chronic situations.

Beech House is a pleasant old building — neither big nor small, and certainly looks nothing like a hospital. Unsurprisingly, it is draughty, as deduced by Sherlock once he notices that the staff are all sporting jumpers, cardigans or jackets. Psychiatrists do not wear white coats unless working inside a somatic hospital, which unsettles Sherlock; he prefers the disguise the coat gives him, the credence it lends him when he fumbles. He is well aware that he looks younger than many of the other medical students, which undermines his standing with patients and makes him feel even more anxious in their presence. Casual clothing would only accentuate the impression, and he prefers form-fitting clothing, anyway, so he's wearing an old pair of black trousers and a navy jacket from Charles Tyrwhitt, with one of the shop's pure-cotton white shirts underneath. Standing beside him in their supervising psychiatrist's appointment room, Wilkes blends in much better with the staff in his expensive, knitted jumper and dove-grey herringbone tweed trousers.

Their supervisor, Charlotte Standish, is a registrar, meaning that she has been accepted into specialty training, and has advanced to the final years of her rotations. She'll be a consultant in a year or two. Sherlock finds late-stage trainees better teachers than many consultants; they still remember the challenges of being a student and are often much more tolerant of hesitation and apprehension, less prone to grill students on their theoretical knowledge.

Not that Sherlock would mind a Socratic approach; theory is his strong suit. He is constantly astonished at the lack of background knowledge of his fellow students. Instead of reading the assigned materials through at the start of each course, they seem to focus their efforts on memorising just enough during the final weeks to pass the exams. Sherlock thinks that is wasteful of the learning opportunities they are offered during courses. If he can't demonstrate sufficient knowledge of anatomy and surgical theory in the OR, no surgeon will let him do anything. Are other students truly content just to muddle through each day's compulsory activities with just the weekend's upcoming parties in their minds? _Imbeciles_. Sherlock had hoped to use the train journey to review some of the notes he'd made from various articles detailing psychiatric interview techniques, but Wilkes had planted himself in the seat across the aisle and spent the journey on his mobile. He was talking to his current girlfriend Arabella, their obnoxious conversation thoroughly distracting Sherlock. Even hearing only one side of the conversation had made him suspect that theirs is a relationship doomed to fail, as Wilkes is only interested in what happens when the two of them are either drunk, in bed, or preferably both.

It appears that Sherlock's hopes of navigating through this attachment without Wilkes getting on his nerves too badly have been futile optimism.

"It's going to be a tough one for your first patient interview, boys," Doctor Standish tells them. "You can call me Charlotte, by the way. We like to be informal here between staff."

Wilkes eagerly adopts this and lays on his usual smarm as he repeats, "Charlotte; what a _lovely_ name."

"So… it's Sebastian and Sherlock, right?" Standish asks, and Wilkes confirms this eagerly.

Sherlock doesn't care what other students and teachers call him as long as it's one of the names from his birth certificate and not something like 'weirdo' or freak'. He prefers the stricter hierarchy and the more formal way of addressing colleagues within surgical fields. He needs to comply with Standish's wishes of a first name basis for the sake of social coherence, but it feels awkward. _Clear rules make things so much easier._ Trying to blur the lines between patients and physicians through dress and behaviour feels like a minefield even if Sherlock can accept the logic that trying to promote equality might put people more at ease when they have to discuss their mental health problems.

He flinches when Sebastian suddenly bumps his arm with his elbow. "Earth to Holmes."

"Ready to get to work, Sherlock?" Charlotte asks him, trying to engage eye contact.

Sherlock curses inwardly for allowing himself to get lost in thought. He nods, embarrassed.

"We'll be seeing an urgent referral from a local GP, a Mrs May Cavendish. Her daughter has died in the early hours of the morning as the result of domestic violence. Her family physician thought it best that she be referred to us to plan how to best support her. Because of the police interest in wanting to interview her and the acute and traumatic nature of the issue, she's jumped the queue, and we can see her today."

Sherlock frowns. He understands that such a situation causes immense stress on a person, but couldn't family offer the same — or even better — help than some psychiatry unit? A GP can make a sick leave recommendation and prescribe benzodiazepines for a calming effect and to enable rest, so why has she been referred to the unit?

"What was her daughter's name?" Wilkes asks.

 _How is that relevant?_ Sherlock wonders. _She's dead_.

Charlotte picks up a faxed referral sheet. "Ann."

The buzzer on her door sounds and, as she walks to answer it, she nods towards two chairs on either side of her desk. "Have a seat. I'll start with some basic questions, and you can then take turns continuing. I know you're only learning the basics, but we can't approach this like a textbook history-taking session. What we can do is to learn something about communicating with a patient who is in a distressed state and who needs support to be able to co-operate with the police."

Both students dig out pens and notepads from their bags. Sherlock takes the chair closest to the window; it will make him appear more an observer than a participant. The best he can hope for is to avoid making too many mistakes. A low profile is going to be essential, but he loathes the fact of having to rely on Wilkes to take the lead in their forced partnership.

Nevertheless, it will be a relief if Wilkes does most of the talking with this patient. The boy is a social butterfly who prides himself in being on first-name terms with everyone and knowing everything about them. There's something fake and oleaginous about the way he acts; it makes Sherlock feel as though he always has an ulterior motive. Still, he seems to be good at making people want to be around him and tell him things.

Escorted by Charlotte, Mrs Cavendish enters the room. She is in her early sixties with an obvious bunion that's troubling her, shoulder-length hair that's a bit messy, old corduroy trousers and a mustard yellow cardigan. She has missed a button, and there's a stain likely from cake frosting in the back of her sleeve she probably hasn't noticed. Sherlock wonders if it would be helpful to point it out.

Mrs Cavendish has a haunted look about her, and she greets the two students with a jerky nod.

Wilkes springs to his feet. "Good morning, Mrs Cavendish," he offers along with his hand for shaking. Sherlock notices that the expression on Wilkes' face is not the usual sneering smile; there is something else there, something careful and intense, but he cannot identify its significance.

While the patient takes Wilkes' hand with a quiet 'hello', Sherlock doesn't rise from his chair. He's not a fan of shaking hands, and the act goes against good hospital hygiene.

Doctor Standish introduces them. "This is Sebastian and Sherlock, medical students who are learning psychiatry in our unit this week. Did Grace at reception ask you if it's alright for them to be present during this interview?"

"Yes, she did. It's alright," Mrs Cavendish says hesitantly. "Students must learn, don't they? My Ann was always a good student." Her voice wavers a little.

Charlotte directs her into one of the comfortable armchairs in front of the desk. Sherlock has read that psychiatrists prefer to create such a physical environment of equality instead of sitting behind a desk.

"I'm very sorry we must meet in such circumstances as this," Charlotte offers.

 _Establish initial rapport_ , Sherlock recalls from his preparatory reading. There had been a chapter about interview techniques he had made notes on. _Express interest and empathy; encourage patients to tell their story in a manner that will demonstrate their thought patterns._ All these instructions in the textbook carried the assumption that the reader knew _how_ to do such things.

Mrs Cavendish nods, reaching out for the box of tissues on the edge of the desk. "The police––" she swallows the rest of the sentence, and silence falls in the room.

"Yes?" Charlotte encourages gently, perching closer to the front edge of her seat and leaning forward.

"The police said they need to talk to me. Are they coming here?" Sherlock thinks he can pick up fear in Mrs Cavendish's tone of voice. _Why would she be afraid to talk to them?_

"No, I'm afraid that will happen separately. Is that interview something that worries you a great deal?"

"Yes…. I know that they need to do their job, but it's just so awful. The thought of talking about it to them is just too, too horrible. I can't bear the thought of having to talk to them. They can't show me pictures, can they? Why would they? It's enough, seeing Ann like that––" Mrs Cavendish readjusts the purse she has in her lap, opens its zipper and then closes it without taking anything out or even peering in. Her hands are shaking, and her tone is confounded and urgent at the same time. "The police didn't do anything when Ann asked for their help before, did they? Useless," she curses.

The sudden fierceness in her demeanour surprises Sherlock. She seems unpredictable, volatile and brittle in a way that makes him deeply uneasy.

"Is it alright to talk with us about last night?" Charlotte asks. "We're not the police and anything you say here is covered by patient confidentiality."

Sherlock is annoyed by the question. What would be the point of this appointment if they _didn't_ talk about last night? The patient has been referred here because of those events. It would be a waste of everyone's time not to get to that promptly, especially since the appointment time must be limited. He shifts in his seat, antsy for Charlotte to the get to the gist of the issue. Were Mrs Cavendish presenting with a physical complaint, the interview part of the proceedings would be in full swing by now, asking the patient to explain what symptoms had brought them to the doctor.

It takes a few moments for the patient to continue talking. When she does, the story practically pours out of her, only interrupted by bouts of near-hysterical sobbing and blowing her nose into the tissues.

Ann, the daughter, had been in an on-off relationship with a man she'd met online — one who had turned out to be the opposite of Prince Charming. After a breakup, during which the man had not given Ann much peace and quiet, following her around Peterborough, they had reconciled, but an argument had led to the tragedy of last night. Mrs Cavendish says she had never liked the guy, but Sherlock is sceptical of some of her statements — in hindsight, it's easy to claim that one had anticipated what would happen. _She is in such a state of shock that she couldn't have predicted the outcome of that relationship, could she?_

Charlotte's questions are careful, vague, polite. Sherlock is not getting a very clear picture of what, precisely, had transpired in Ann's apartment, nor is it clear whether the suspect is in custody. _Elicit specific information_ is what all the structured instructions on psychiatric interviews had listed as item number two. _Facts of the history and the present state of the chief complaints should be explored, and the patient's mental status formally tested._ Then again, Sherlock wonders if, in an acute crisis, structured questionnaires are not often used. Charlotte's instructions had seemed to point to a more improvised approach. Mrs Cavendish had not been given any screening questionnaires to fill before the appointment. _Is she actually in a state of acute mental distress requiring medical intervention?_ _Surely counselling by the police's family support unit is a more logical channel._ Sherlock finds himself wondering why the woman had been referred to Beech House, and why a GP would have done so this quickly. It seems to be connected to why she is reluctant to talk to the police. It could be just because she is disappointed in their efforts, but why the fear and not just anger?

"Would you like to ask anything at this stage before we move on to Mrs Cavendish's medical history?" Charlotte asks.

Sherlock straightens his back. "Do you think your daughter provoked him and is that why you don't want to talk to the police?" He asks. There's no other reason for her hesitation that he can think of.

Mrs Cavendish's eyes go wide. "How _dare_ you! It wasn't her fault!" She begins sobbing disconsolately.

Charlotte gives Sherlock a look of very thinly veiled disapproval and rests a hand on the patient's shoulder. "I'm sorry, Mrs Cavendish — may I call you May?"

The patient nods.

"We don't have to talk about such details, now, as clearly they are very distressing." Charlotte continues. "Of course, nobody's blaming Ann."

"But––" Sherlock protests, "––don't we need to know _why_ she doesn't want to talk to the police? You've said this appointment is important for that. How can we establish motive or discern whether the crime was premeditated without understanding the criminal's _modus operandi_?" He had found the forensic psychiatry textbook much more interesting than the other course material he'd studied over the Christmas break.

"We're not here to assess the person who hurt May's daughter; we're here to help _her_ ," Charlotte says sharply.

"What was Ann like?" Wilkes asks. "Did you see each other often?"

All the articles had instructed to avoid asking many questions at once and to favour open-ended questions. _Wilkes has obviously not prepared for this at all._

Mrs Cavendish crumples up a tissue into her fist, and a sad smile is now twitching up the edge of her mouth. "She was my first child. Always with the boys, that one. I wondered if she just couldn't quite cope being on her own. She is — _was_ — quite the artist, but she didn't want to leave here to try for any of the big art schools in London. She wanted to be close to us, came by at least three times a week for tea and to nick the paper; now it's just me after my Craig passed away. She was angry as could be when her brother moved to London, and now he's in New York. Our village girl, I called Ann. Not much of a dating scene around here, which was something she always complained about, said none of the local boys were to her liking. No wonder she tried one of those online dating things. That's how they met."

Wilkes nods sympathetically. "So sorry to hear about what happened to her. Sounds like you had a lovely relationship."

Sherlock rolls his eyes. They're still not gathering any useful information, just rambling on about inconsequential things. What does it matter if Mrs Cavendish made crumpets for her daughter two, three, or eleven times a week? Why is she _here_?

Looking up, he catches Charlotte looking at him with a warning in her eyes. "Sherlock? May I have a word outside? Sebastian, perhaps you could get Mrs Cavendish some water?"

"Certainly," Wilkes offers eagerly and goes to the sink at the back of the appointment room.

In the corridor, Sherlock clasps his wrist with his other hand, bunching up the jacket fabric in his fingers to curb his nervousness. What has he done wrong, now? This is their first interview, and while Wilkes is allowed to waste time with sentimental nonsense, he's already being singled out.

"That lady has been through hell in the past twelve hours. I won't have you disrespecting her," Charlotte says. She doesn't sound angry, just determined. "Your questioning needs to be sensitive to the patient's needs, and that one about the motivation for the crime was inappropriate. I can see you're frustrated and disinterested, but I have to remind you this is a compulsory course you must pass just like every other student."

"I'm not _disinterested_ , and no disrespect was intended!" Sherlock protests. "It's just that we're not getting anywhere when it comes to understanding why she won't speak with the police. A quarter of what I assume in an hour reserved for her assessment and the establishing of a treatment plan has already passed, and we have not established the precise chain of events leading to her referral, nor have we explored her prior psychiatric and medical history or done any structured assessments of symptom panels. We don't know why she is here, and that seems a waste of everyone's time if the aim here is to get her to assist the police."

Sherlock can't help thinking of Professor Langton, who'd been in charge of the traumatology course. He would have had any student's hide who wasted fifteen minutes yapping about pointless things instead of promptly establishing medical history, current complaint, physical status and imaging results. _Traumatology is a dull, ineloquent specialism suited for those who want to hammer in nails, but at least its diagnostics are based on concrete things._

"A waste of time? Let's challenge that idea," Charlotte muses. "We _have_ established that Mrs Cavendish's verbal output is coherent, she is oriented to time and place, she is not catatonic or psychotic, her emotional responses are appropriate for their context, she has been able to dress herself appropriately for the weather and even apply some makeup, which signals she retains abilities for self-care despite the acute crisis she's facing. Judging by this, I already know that an outpatient approach for her continued care is a possibility and that she is likely a person with somewhat sturdy mental equilibrium trying to cope with what for many would be an acute mental health crisis. A suitable diagnosis may well be F43.2 — Adjustment disorder, meaning a state of subjective distress and emotional disturbance arising in a period of adaptation to a stressful life event. If that is the case, then her prognosis should be good."

Sherlock takes this all in. "Oh."

He finds he can accept these statements but cannot quite deduce how Charlotte has arrived at them. _It hardly seems very scientific._ "But why has she been referred? I mean, family members die, even under shocking circumstances, and that doesn't result in acute mental health conditions requiring specialist treatment. On what basis do you think this is an adjustment disorder?"

Charlotte sighs. "That is exactly what we are trying to find out. Her inability to speak to the police at least makes this urgent; the GP note says she was quite confrontational with them at the scene. That can be explained by her frustration with the police's lack of action when the suspect was following Ann around during their separation. She may well be able to be interviewed now that she's been able to vent to us."

"So this entire appointment may not lead to any psychiatric treatment at all?" Sherlock asks.

"Sometimes, the assessment can act as a part of the therapeutic process. We're listening to her, showing empathy, providing a chance for her to talk about last night in a safe environment. Perhaps, after a few conversations, she'll be comfortable to talk about such things as you asked about."

Sherlock would never consider a psychiatric unit a safe or comfortable place to talk about anything. What he has experienced in such places is being pressured and confused and punished and made to do boring and difficult and upsetting things. He doubts adults are generally any more comfortable being sent to talk to mental health professionals.

"Your question was a good one, but we can't just go out and ask such things without doing a lot of groundwork to establish a good rapport with a patient," Charlotte explains. "Would you like to sit the rest of this interview out?"

Sherlock shakes his head. He will _not_ be kicked out right at the start. "I will be quiet."

"Not what I meant. I was just giving you an out if you find that something about this particular patient is putting you off. In fact, if you're willing to have another go, you can ask about her prior history next. Once the patients have been able to explain what's happened that's been traumatic, they can often relax a bit and find it a relief when the conversation is steered to less emotionally heavy topics."

Sherlock remembers their mock practice interview instruction sheets saying something similar.

They return inside, where Mrs Cavendish is showing Wilkes a photograph she must have dug out of her handbag. It's a picture of a baby boy and an older girl; it must be her two children.

"Sorry for the interruption," Charlotte says. "Where were we?" she asks, giving Sherlock a glance of encouragement.

He retakes his seat and forces himself to meet the patient's wary, expectant gaze. "Mrs Cavendish," he starts, then clears his throat, "Have you ever met with a psychiatrist before?"

"No, never."

As far as Sherlock can tell, she doesn't seem upset by the question. _Good_. It means she is likely telling the truth. "Has any other physician diagnosed you with a mental health disorder?"

"No, they haven't."

"Are you currently on any medications?"

She purses her lips. "I take something for my cholesterol, Lipitor I think it's called, and a multivitamin tablet whenever I remember."

Sherlock has plenty of opinions on vitamin supplements, not many of them favourable, but he decides the topic is irrelevant to the situation. "Do you have any chronic conditions we should be aware of?"

"What does that mean?"

"Long-term illnesses, Mrs Cavendish," Wilkes explains.

"I have an arthritic knee, but they say it's not ripe for surgery yet. I can manage. I take an occasional bit of those things you can buy over the counter, ibuprofen and such. "

Tempted to ask for details on the knee issue, Sherlock bites his tongue. _Not relevant_.

"What was your profession?" Eye contact is not something he enjoys, so he keeps his gaze down on his notebook.

"I taught primary school in the village, on my feet a lot which is why the knees give me grief. Retired four years ago, around the same time as my Craig sold his business. We had planned on travelling, but then he died suddenly." Her eyes well up with tears again.

Hoping the burst of emotion will soon pass, Sherlock takes a moment to write down _'educated, employed, retired'_. "How did your husband die?"

"He had a heart attack while driving to London. The police called me to tell me he was dead and that his car had crashed into others; three other people died."

Before Sherlock can resume his questions, Wilkes butts in, "That is so sad. How did you cope with the news and such an unexpected loss?"

"It was devasting. It took me ages to… I suppose I'll never really get over it. We'd always planned on having a long and happy retirement, just enjoying life."

Sherlock glares at Sebastian for interrupting his line of questioning — just when he'd felt he was getting somewhere!

"Did you see your GP when your husband died?" Charlotte asks.

She shakes her head. "No."

"Why not?" Sherlock asks.

Mrs Cavendish's brow furrows. "There was no point. Our Doctor Wilson had retired; he'd been looking after us as a family for years. The surgery is now staffed by young people; you never knew who was going to see you. It was Ann who kept me going. She was the one who said it wasn't her dad's fault, just an accident." She's crying again, scrumming up the sodden tissue between her fingers. "And now that bastard's gone and done it, and she's gone, too…." She uses the tissue to stifle a sob.

Sherlock returns to his mental checklist of questions he'd memorised from the text. _A history needs to identify what support network is available_. "How would you characterise your primary family?"

Mrs Cavendish frowns. "What's a … _primary_ family? I've only been married once."

"What Sherlock meant by that is asking about your own parents and whether you have any siblings or close older family living nearby," Wilkes eagerly jumps in to decipher, giving Sherlock a sneering glance.

"Oh."

Their patient launches into a lengthy ramble about her childhood in North Yorkshire, most of which Sherlock tunes out. Once she says that there was no family nearby, the rest hardly seems relevant to the situation, even if the literature says that coping mechanisms are learned in childhood. _How could anyone learn coping mechanisms for their child being the victim of homicide, or a husband inadvertently killing three people?_

With some more textbook questions quoted from memory, Sherlock establishes that there has not been any significant mental illness in Mrs Cavendish's immediate family or even in more distant relatives as far as she knows. Her living older relatives — an aunt and an uncle — are in a retirement home in Scarborough; an elder sister is dealing with some sorts of chronic pancreatic problems in America.

"You mentioned that your son lives in America as well. Is he aware of what has happened with Ann?" Charlotte asks.

She sighs. "I called him. Of course, I did. Tom says he can make the funeral whenever that is going to be. But…" Her face crumples again. "He reacted the same way when his father died. Oh God, I'm going to have to go through all that again. The funeral director, the solicitors, and first the police. Ann helped with it all when my husband died; who's going to help me now?" She breaks down into tears again.

Wilkes steps in. "What about the village? Have you got friends, people upon whom you can rely, maybe the vicar?"

Mrs Cavendish looks up at him and shakes her head. "Not any longer. It's a small place. Once the village school closed, the shop went. The vicar retired almost a decade ago, and now we get a service once a month from some young fellow who comes in from town. Not that I've ever been a believer; just did it because it was part of village life. That's all gone now. Everything's changed… Mostly middle-aged in-comers now, and they work during the day. Nobody has time for the old folk anymore, lots have had to sell up, go into care homes or move into sheltered accommodation that the Council put up in the market town. Ann used to take me there to see the one or two friends I still keep up with. I don't drive, so Ann is — _was_ — my lifeline."

 _Limited support; possible undiagnosed depressive episode during the previous bereavement?_ Sherlock jots down in his notebook _._

Mrs Cavendish's comments make him think about his own mother; thank God he got out of their small village and out of her micromanaging clutches. _No wonder_ _Ann was so keen to date; I bet she secretly wanted away from a mother who was this attached to her._ Since the patient has no local support network, the GP's referral may well have been a matter of routine, further triggered by the police being told she wasn't up to talking to them.

When neither he or Wilkes seems to be coming up with more questions regarding social and developmental history, Sherlock caps his pens and looks at Charlotte.

"Thank you, Sherlock and Sebastian; that was… very thorough," Charlotte says. "Now, let's talk about what happens next."

______________

The plan is for the Locality team to have daily phone contact with Mrs Cavendish until her son arrives from America, and for Charlotte to meet up with her in three days' time. A referral for psychological counselling will be made, then, if needed. Mrs Cavendish agrees that one of the unit's psychiatric nurses will accompany her to the police interview. A small packet of short-acting benzodiazepines is prescribed to deal with her anxieties and to help her catch some sleep at night.

By the time all of these arrangements are made, they are already late for the next appointment time. Thankfully, it's just a final check-up for a patient who'd experienced a brief psychotic episode managed in an outpatient setting connected to insomnia, stress and party experimentation with drugs. He's in his early twenties just like Sherlock and Wilkes, and a Cambridge law student. Initially hesitant about the two students' presence, he seems to relax when Charlotte assures him that all present are bound by the code of confidentiality. All symptoms have abated, the patient's GP will be monitoring the situation in the future, and this first experimentation with LSD has left the young man so frightened that he says he has no further interest ever to experiment with illicit substances.

Sherlock listens to the patient's story with interest; hallucinogenic substances he has no personal experience of, but he finds their pharmacology quite fascinating. The appointment is short and to the point; Charlotte steers the proceedings without giving the two students much of a role, presumably to catch up on their timetable. Sherlock wonders if it's also in deference to the student's caution around his peers.

The day's third patient is a railway engineer who's lost his job, and his marriage is on the rocks. It's a referral from the police after the wife reported him missing, and there had been fears that he might be suicidal.

The patient keeps denying it. "A bloke can go walkabout when he's pissed off at the shite that the world has been throwing at him," is how he explains his behaviour.

A history is taken, an initial diagnosis of depression is made because it turns out that he has apparently had similar episodes all his life but never sought treatment because telling the company occupational health physician would have, quote, "Cost me my job, so like that's never going to happen." The patient is not particularly keen to be at the clinic: "Is this going to go on my record? For Christ's sake, it's hard enough getting a job these days, so I don't need this."

Sherlock is reminded — as if he needed to be — that mental health issues create a stigma that damages employment prospects, something that he's determined is never, ever going to happen to him. Not even Wilkes seems very sympathetic towards the brusque-mannered man, but Charlotte's gentle and sunny manner never wavers. She defers to the students with the past psychiatric history-taking once again; Sherlock lets Wilkes do the questioning as his thoughts are still slipping back to Mrs Cavendish.

How can he ever know what questions are appropriate, and when? He thought that he was following all the reference literature to a T. Is it as he has feared — that he could memorise a thousand psychiatry textbooks yet still keep hitting his head against a wall when it comes to applying them to practice? If only they'd just let him sit quietly, not participate, and somehow get through this course!

The next patient refuses student presence, giving Sherlock and Wilkes an hour and a half for lunch. Without a word, Wilkes marches across the road to a pub while Sherlock opts for a sandwich from a small cafe nearby.

When they reconvene with Charlotte in the clinic's break room, she is having lunch, too — a homemade salad with a bread roll. "Well, how do you feel about your first morning?"

"Excellent," Wilkes announces. "A good variety of complaints."

Charlotte nods. "Quite a collection, really. Could have gone a lot worse with Mrs Cavendish, but you did well in reassuring her," she commends Wilkes.

Sherlock is looking at his hands, fingers tugging at the edges of his dress shirt sleeves. He wonders if she has just insinuated that Wilkes had salvaged a situation he had nearly wrecked.

"Sherlock? Any thoughts?" Charlotte asks.

He finds it hard to put his frustrations into words. "Challenging."

"That's okay. At least you're being honest. I've got something for both of you," Charlotte says, and gives each student a printed sheet of paper. "It's a set of guidelines I found very useful when first starting out in the field."

It's a copy from an article Sherlock had already found and memorised during the holidays. The advice it contains includes: " _Provide structure to help patients who have trouble ordering their thoughts. Phrase questions to invite the patient to talk by favouring open-ended, nonleading questions. Use the patient's words. Be alert to early signs of loss of behavioural control. Identify the patient's strengths as well as their weaknesses. Avoid jargon and technical language. Avoid questions beginning with 'why'. Avoid premature reassurance_."

Sherlock realises his questioning to Mrs Cavendish had not fulfilled many of those recommendations.

Their afternoon is spent listening to a seminar for trainees, where one of them gives a presentation on the updated treatment guidelines for bipolar disorder. Afterwards, they join Charlotte to go through the pile of new, non-urgent referrals assigned to her and discuss the contents. Well, mostly it's Charlotte and Wilkes discussing them. They seem to be getting on well as far as Sherlock can tell. He does wonder if Wilkes shouldn't be treating her with a bit more professional distance and subordinate respect. Instead, they're chatting like friends.

 _Then again, what would I know about that?_ Sherlock wonders. _I've never really had any, apart from Victor_.


	5. Inappropriate

It's four o'clock in the afternoon, and Sherlock is fighting a losing battle against ennui.

This week, their placement is at Addenbrooke's A&E department, where their supervisor of the day is Alison Threadgill, a psychiatric nurse trained as an Approved Mental Health Practitioner. It means she is authorised to deal with patients potentially requiring sectioning under the Mental Health Act. Once two medical recommendations for sectioning have been made, it is one of an AMHP's duty to make the final call regarding whether the patient will be detained against their will. Such an approach is, of course, the last resort; many of Alison's patients are co-operative and accepting of treatment.

After he and Sebastian had come in at noon, they had assisted on a referral from a care home: an eighty-seven-year-old female was brought in for a suspected myocardial infarction, but she also suffers from advanced vascular dementia. Her cognitive performance fluctuates daily at the best of times, and Alison needed to assess the acute mental competence of the patient to consent to a coronary angioplasty and insertion of a stent. She needs the treatment — without it, her prognosis can be life-threateningly dire, but she is fearful of staff and resisting treatment.

Sherlock considers the case a mildly interesting example of applying the Reisman scale to determine that the patient is at GDS Stage Four, bordering on Stage Five. He and Sebastian had disagreed over this — with Sherlock arguing for moderately severe cognitive decline against Sebastian's opinion that she had declined even further. Sherlock had been gratified to have his assessment preferred by Alison to Sebastian's, even if it had led the Pembroke College student to glower at him for ages. _He's being ridiculous; this is not a competition but a mission to establish medical facts._ Sherlock doesn't understand why Wilkes always takes it so personally when a conversation reveals something he doesn't know. _Shouldn't he take it as an opportunity to improve his performance and to expand his knowledge base?_ Many questions and comments he's heard from Sebastian during the course signal that he is not anywhere near as well-versed with their assigned theoretical course material as Sherlock is. _How can other students afford to be so lackadaisical?_

Sherlock had found it useful to observe how Alison explained the angiography to the patient in simple terms, using language designed not to alarm her. The AMHP had taken her time, explaining things clearly, repeating herself as often as the patient needed, which seemed to calm her down. Eventually, she had consented and been carted off to the angiography suite at half-past two. Doing the procedure against her will might require general anaesthesia, which in her state would carry major risks. Now, there's hope that they could manage with just a bit of sedation.

Since then, the cases of the afternoon have been dull, dull, dull. Sherlock finds it easy to become more and more disengaged with the parade of routine A&E work because the need for a psych consult is not apparent in wrist fractures, high temperatures in infants leading to febrile seizures or a host of patients who really should be seen in a GP surgery or a minor injuries clinic rather than clogging up a hospital's urgent care services. He'd voiced this to Alison, who had told them not to be picky at this stage in their careers, and to go observe whatever else was going on at the A&E department while they waited for the next patient needing a psych evaluation. Sherlock had welcomed the suggestion, but there were already other students shadowing the trauma and soft tissue surgical trainees, leaving him little to do. Sebastian had opted for settling into the cramped break room with a coffee and a stale, soggy Danish pastry from the cafeteria. That's where Sherlock, frustrated and bored, had eventually wandered into, and they are sitting now in a pair of chairs.

Sebastian attempts to engage Sherlock in his routine but random disrespect for colleagues and other healthcare employees who have picked careers he doesn't understand. "They probably invented all of these titles so that they wouldn't have to pay to train enough psychiatrists. AMPH — sounds like some adrenal deficiency. A noctor, a demi-doc."

Sherlock understands the nasty dig implied by the latter but is not familiar with the former. "What's a noctor?"

" _Not Doctor_. Something you'd better become familiar with; at the rate you're going, Holmes, that's your future job title."

Sherlock won't rise to the bait. If there is anything that his school days at Harrow had taught him, it was not to allow this sort of provocation to engage his energy. It was always just best to ignore it, and Wilkes is probably stooping this low because his assessment of the dementia patient had been gently but firmly shot down by Alison. Sherlock can muster respect for those who have more training and experience than he does in psychological issues, assuming their attitudes and approaches are not as destructive of those so-called professionals he'd been exposed to in his childhood and teen years. After all, he _envies_ people who can read such things on others and navigate this professional maze of material that is highly confusing for him. Admittedly, like Sebastian, he would prefer to shadow a doctor instead of a nurse, even if Alison is a highly trained and specialised professional.

His mind wanders to a particularly interesting surgical procedure he'd been lucky to observe two days prior when attending the concluding hours of an elective surgery course. He'd watched an ENT surgeon working with a neurosurgeon on a trans-sphenoidal pituitary operation to remove a Rathke's cleft cyst. The patient had been suffering from severely debilitating headaches, and the standard drainage treatment had not alleviated the symptoms, requiring a more invasive procedure. The two surgeons doing the case used an endoscopic approach — minimally invasive, compared to the old-fashioned technique where a large part of the nasal septum needed to be removed to allow the surgeons to insert a retractor so they could see into the sphenoid sinus and pituitary. Sherlock had started work on writing up the case for his elective course portfolio for that unit that same evening, wanting to memorise and learn more about all the details. Why couldn't he be doing something like that right now, instead of sitting in this chair like some redundant piece of outdated medical equipment? _They should offer a tailored medical school programme for those planning a career in surgery with all the useless parts cut out._ Alternating between utter boredom and high anxiety, he cannot imagine what benefit any of this psychiatry module will be for him in an OR.

After three weeks, he's no nearer to finding a case of his own for the psychiatry portfolio. The group case had been decided on in a vote of five to one, his being the only dissenting vote on a post-natal depression case. _Boring._ The case reminded him uncomfortably of last term's excruciating Obstetrics & Gynaecology unit, and if there was one topic in psychiatry to which he could relate the _least_ , it would be someone's mindset after giving birth.

"Oi. Earth to Holmes."

Wilkes prods Sherlock in the side, making him flinch away and snarl, "Hands off, you berk."

"Don't be so touchy. Just trying to spare your blushes when the next psych consult is called. Wouldn't do to be asleep, would it?"

"Piss off." As soon as the words are out of his mouth, Sherlock knows that the volume control on his voice is all wrong, an assessment confirmed when one of the nurses in the staff room hears the annoyance in his tone and gives him a stern look.

Whatever retort Sebastian is about to come up with gets cut off when Alison appears in the doorway.

"Right; we're on. Fourteen-year-old female brought in by the police, in crisis, uncommunicative. She went missing from school and was found wandering down the middle of Hills Road, oblivious to traffic. You two are going to help me take a patient history and make a mental health state assessment. The mother is here and has consented."

The three of them walk down the row of curtained cubicles. When they've entered the last one in the row, the AMHP closes the curtains behind them and turns to the two females there.

"Hello, Mrs Sheldrake; I'm Alison Threadgill, and this is Sebastian Wilkes and Sherlock Holmes, the medical students Nurse West mentioned. I am just going to check that you and Phoebe are okay for them to observe and to take the medical history."

"No problem. I'm sure this won't take long." Mrs Sheldrake is a willowy blonde in her early forties, immaculately dressed and make-up meticulously applied. She primly repositions an expensive-looking handbag on her knees.

Sherlock deduces her as a stay-at-home mum, one of those 'ladies who lunch' — university-educated but not the least bit career-oriented. She has not worn this outfit all day, only a few hours. She is very comfortably well off if the designer labels she's wearing, and the impractical-looking bag, are anything to go by.

What Sherlock can't work out is the expression on her face. The exaggerated calmness of it and the joyless, sharp smile confuse him in the context of why her daughter has been brought in. _Surely, she should be more concerned?_

Perhaps because he is still working that out, Sebastian is first off the mark.

"May I see that?" he asks Alison, who passes him the clipboard holding the patient's police report and intake form. "Hello, Phoebe. We'd like to ask you a few questions. Are you okay with that?"

The teenager is sitting on up on the hospital bed, looking a little bedraggled. She's pulled her short black skirt down while her school uniform jacket's sleeves are pushed up her arms. The white blouse's cuffs are unbuttoned, and the sleeve on her right arm has been folded up to take a blood pressure cuff, still in place but uninflated. A brown plaster at the crook of her arm with a drop of red having seeped through points to bloods having been drawn. Her hair is short, and a bit raggedly cut in a style that does not flatter her face. It's in stark contrast to her mother's trendy, meticulously coiffed look.

"Phoebe, answer his question."

The command from her mother is ignored, and the girl is looking down at her hands that are now twisting a cotton handkerchief.

The mother sighs. "Just ask me; if Little Miss Impolite suddenly deigns to chip in, she will."

Sebastian turns his attention to Mrs Sheldrake and offers his patent plastic smile before glancing down at the police report. "I understand that Phoebe is fourteen; her fifteenth birthday is coming up in three weeks."

"Yes." Mrs Sheldrake is glaring at Phoebe.

Sebastian continues. "So, you've been informed that the police found Phoebe wandering down the middle of the road in a confused state?"

Mrs Sheldrake nods. "Yes."

"They found her student ID card and called the Sancton Wood School, and brought her here for examination, and the school telephoned you."

"Yes, precisely." Now there is a bit of impatience in the mother's tone.

Sherlock has no idea why Sebastian is stating the obvious unless it's to hammer home with the mother what has happened.

"Phoebe, can you explain to us why you were doing that? Was something upsetting you?" Sebastian asks.

Sherlock watches as his fellow student ducks his head a bit, trying to get in the girl's eye line. It doesn't work. She ignores him and uses her right hand to tug at the skirt again. The gesture seems anxious, compulsive. Sebastian turns away and raises an eyebrow to the mother, in effect asking her if she knows what the problem might be.

Mrs Sheldrake sighs. "It's those beastly girls again, I expect. She's being bullied by a group of them at school; they're on at her about the way she looks, probably why she won't wear make-up or use nail polish. I've told her the best way to avoid this is to try to blend in, make more of an effort on her appearance, but she won't listen. Won't do anything to make herself presentable. She got that hideous haircut last week; she used to have such lovely long straight hair, straight out of a fashion mag."

Sherlock asks the girl, "Are you a day girl or a boarder?"

The mother answers immediately for her: "Day girl. We've told her over and over again that we'd be happy to pay the residential fees. Lord knows most of the girls are boarders, and of course, they are going to look down on her because they think she can't afford it, and they can spend all that time together in the evenings so of course, she can't become the same kind of a part of the group if she's at home. I should know, I was always a boarder. But, no matter how much we encouraged her, she wasn't having it. How to make her understand she needs to make an effort, too, is beyond me."

Sebastian now reinserts himself into the questioning — as if jealous that Sherlock had intervened. He doesn't make a further attempt to ask Phoebe anything; instead, Mrs Sheldrake gets asked the next set of questions. She explains that no, Phoebe has not had any problems with her schoolwork; no, she's not had any incidents like this before. She's not on any medications. No, she's not been stressed about the GCSEs coming up; she's been studying quite diligently at home. "In fact, I wish she would go out, do more with friends. She used to be quite sporty, but even that disappeared last year."

"Phoebe, apart from studying, what do you like to do at home? " Sherlock interjects before Sebastian can fire off more questions.

Mrs Sheldrake tuts, "Just buries herself under those dratted books and draws. Draws and draws, that's all she does, but when we asked if she wanted some art school lessons, you can guess the answer."

Sebastian glances at Sherlock, shakes his head and raises a brow as if to say _'so what_ '?

As he continues interviewing the mother, they learn that Phoebe has had no hospital admissions since she had her tonsils out at seven.

A nurse pops in and hands Alison a print-out which she passes to Sebastian. He reads it and then says, "Good news; no sign of drugs in the tox screen."

Mrs Sheldrake looks scandalised. "Drugs?! I should hope not."

"It's routine to rule out drugs and medications and alcohol in these types of situations," Alison explains, and Mrs Sheldrake seems to settle.

"She's not one of those…. Potheads or pill-takers. Doesn't smoke or drink." She gives a bit of a sad smile. "Not one for parties, our Phoeb. Doesn't take after her mother at all," she jokes.

Once again, her light tone and dismissive attitude are raising Sherlock's hackles. Clearly, Phoebe has some problem that has led to her strange and alarming behaviour, but the mother doesn't seem to be on the same page at all. _She seems to think the girl is being difficult on purpose_.

Sherlock decides to deviate from the standard questionnaire, as it isn't getting them anywhere. "Phoebe, when was the last time you spoke with your mother?"

There is no answer, and Mrs Sheldrake rolls her eyes. "This morning; the usual one-word 'bye' as I dropped her off. She's not exactly chatty in the mornings."

He realises what it is about the mother's manner that grates so much on his Sherlock's nerves: her insistence on speaking for her daughter. She won't even give her a chance, won't look at her or wait to see if she might open her mouth. She also belittles the girl to her face. _Doesn't she even want her to open up?_ It appears that the mother is trying to just get through this as fast as possible instead of Phoebe getting the help she needs. _Does she feel that the girl has embarrassed her?_ While Sebastian has focused on the mother, Sherlock has been watching Phoebe. There is something decidedly off about her posture, her refusal to make eye contact. She seems more nervous than annoyed, the way a teenager might be when an adult presumes to answer for them. _Maybe she's used to that_. It's clear to him that all she wants to do is get out of the room as fast as possible — just like her mum. Sherlock can understand that, just as he can relate to profound frustration over a parent who always thinks they know what's best for even their nearly adult children, and who vocally expresses their misguided opinions at anyone who's willing to listen.

Sherlock's eyes narrow as he focuses his whole attention on the girl. He takes in the red and shredded cuticles, the firm left hand holding her skirt down, the rim of bloodstain under the bitten nails of the right hand. _Why the haircut, and why's the fabric of her skirt on the right side doing that…?_

The mother's patience is running out. "Look, I know you feel like you need to ask all these questions, but I'm sure it's all just a case of her being a bit tired with all that schoolwork and not concentrating with all those teenage hormones. Maybe the police over-reacted, seeing her on the road; she might well have just done a bunk to avoid another confrontation with those girls. I've told her to tell her teachers about it because the school has an anti-bullying code, but unless she's brave enough to tell me chapter and verse and repeat it later, there's no point in me going to the Head to complain. No one's injured or needs to see a doctor. We'll go home now, Phoebe. Next time you want attention, just open your mouth instead of trying to get run over on the road, hmm? She's fine. Just a misunderstanding, I'm sure. Sorry to have wasted everyone's time."

Alison regards Phoebe with a frown. "That's a possible theory, yes. Phoebe, do you also want to go home now?"

This gets a vigorous nod of the head from Phoebe, but she won't raise her eyes. Her right hand is pressing down hard on her left thigh as if she would rather leap up from the bed and run.

Without knowing what the police had seen, and without any input from the girl, Sherlock can see that the AMHP is starting to lean towards doing what the mother wants. Sebastian and Alison exchange glances and Sherlock can see that a decision is approaching, even though nobody has unearthed any real answers to explain the girl's unusual behaviour.

_They look at her, but they're not really observing, are they? She was walking in a daze in the middle of traffic; isn't such self-destructive behaviour alarming enough to warrant more questioning?_

"I'll get the discharge form," Alison takes the papers from Sebastian and reaches for the curtain, ready to leave. Sherlock grabs a pleat of the curtain to pull it back around the cubicle, leans forward and puts his hands on the edge of the mattress of the hospital bed. "Phoebe, would you please lift up your skirt and show us your thighs?"

There is a momentary gasp from the mother, and then a shriek of " _WHAT KIND OF A QUESTION IS THAT?!"_

The AMHP steps forward. "A totally inappropriate question is what that was. Mister Holmes — you will step out immediately."

Startled by the reaction of the women, Sherlock attempts to explain, "But we need to check–– we haven't really examined the possibility that she might be self-harming in other ways than just not caring if she gets run over. Phoebe's––"

"No longer any concern of yours," snaps Alison. "Out, _now_."

Sebastian is rolling his eyes in disbelief. "Do you want me to go, too?"

The AMHP nods. "It's just as well. Escort him the staff room and wait for me there."

"Come on, _freak_ ; you've done it now." Wilkes grabs Sherlock's arm, and half drags him out, stopping only long enough to pull the curtain back in place.

As he pushes Sherlock down the corridor, they can both still hear the mother's outraged words: "I want to make a complaint; who do I see about this?"

They can also still hear Alison trying to calm her. "Of course, you can make a complaint. I will get you a form, and you can contact our Patient Advisory Liaison team. Don't worry; I will report this to the faculty as unprofessional conduct, Mrs Sheldrake."

________________  
  


Back in the staff room, Sherlock decides it is a generous name for a space the size of about three broom closets stuffed full of old textbooks, rows of small lockers for bags and other personal belongings and a few computers. There's a small sink, from which Sherlock fills a disposable cup with water, and plants himself in a tattered armchair. Wilkes disappears off somewhere, presumably to continue the day's clinical duties with Alison. There's no wall clock, the digital screen on the microwave keeps blinking 00:00 and Sherlock had left his watch in the changing room, so he has no idea how long he sits there, occasionally dodging staff members popping in. They don't ask him who he is, and he doesn't speak to them.

He doesn't dare to leave for fear it'll lead to further punishment, neither does he want to go search for Wilkes and Alison because he's been told to sit and wait here for her to return. He doesn't know what to do, and the longer he attempts to just sit still, the more anxious he gets. At least the room is empty for most of the afternoon so he can stim in whatever way he needs to; whenever the door handle creaks, he flinches and buries his hands under his thighs.

Finally, the person arriving is Alison. She doesn't look angry, just tired. "Sorry to keep you waiting. We had an urgent consult; I've left Sebastian to do a write-up of it. I'll check his work after I've let you go for today."

Sherlock swallows. "What about… the day after tomorrow? I have lectures tomorrow, but we're supposed to come back on Thursday."

"And you will. Mrs Sheldrake chose not to make a complaint, after all, based on the fact that you are still a student. But I'm afraid I had to promise to escalate matters. That means speaking with the Course Lead who may contact your educational supervisor."

"Oh." Sherlock averts his gaze. Any plans he might've had about keeping his head down, maintaining a low profile had just gone down the drain.

Alison pulls up a chair. "Sebastian says that––"

Sherlock's head snaps up, and his eyes narrow. "He _hates_ me. Don't listen to him."

"He certainly had some… opinions. Alright. I did suspect the two of you didn't get along; it's just that he seemed concerned about your clinical performance on this course."

" _Concerned?_ " What Sebastian would have been doing is talking him down to Alison, perhaps in the hopes of being assigned a different partner.

"Can you explain why you chose to approach the patient's problem in the way you did? Why you chose those precise words?"

Why does he get the feeling that she is practising some psychiatric interview technique on him? His anxiety ratchets up another notch, making him struggle to process how best to answer her questions. In the end, he blurts out: "We've been told to be honest and precise and not to shy away from difficult topics."

"Yes, but… Can you understand why they reacted so strongly?"

"Because it was true! And you were about to help the mother sweep things under the carpet by not addressing the obvious."

"It's not uncommon to sense that there is more in a patient's story than what they let on at first; I agree that the mother was downplaying the issue. It's just that pushing through doesn't often produce good results; it might just make the patient clam up and anger their family."

"But if they won't talk, won't you eventually have to do something, to just… just ask them, rather than play games with words that don't actually mean what you want to ask? How do you know that wasn't a suicide attempt? We have no idea what the chain of events was that ended with Phoebe on the road. What was the point of that interview? Why even talk to her if you were going to accept everything the mother said without question? Surely it was better to confront them?"

"Do you trust new people immediately, or does it take time to build rapport?" Alison asks.

"I don't trust anyone."

"Think about your friends. You didn't tell them your most embarrassing or anxiety-inducing secrets on your first meeting, did you?"

"I don't have friends."

Sherlock looks at his shoes. How would he know how such things work? He has no idea how people make friends, how they get others to trust them and want to tell them things. He doesn't want people to know anything important about him.

If Alison is shocked by his revelation, she controls her reaction. "Sometimes, the best thing is to take a timeout, to allow the patient and the family to regroup. I would have insisted on prompt follow-up with Phoebe when I came back with the forms to discuss discharge, and I would have asked Mrs Sheldrake's permission to contact the school to gather more information."

"Oh." It does sound reasonable if a bit slow and passive. How could he have known that was the plan? Why had Sebastian not reacted to Alison appearing to take the mother's word for it and just let them go? Sherlock realises he must have missed some cue, some unsaid thing, some hint which Sebastian would have instantly picked up on and realised what Alison was planning.

He wants to kick something. The teachers keep insisting there are rules to follow, guidelines and well-established practices to patient interviews and taking a history which will produce results, but every time he tries, he finds there's an exception to those rules, something he should have read between the lines. He can't do that, and nobody understands why. His course mates just think he's callous, or slow or–– or–– worse.

 _Freak_.

Alison is giving him a look that he struggles to interpret. "Look, we all make mistakes; I've put my foot in my mouth more times than I can count when I was first starting out," she tries to reassure him. "Provocation can be a diagnostic tool, but only when used skillfully and with serious consideration. It usually only works when a therapeutic relationship has been established, not between strangers. We have to respect patients' boundaries and be mindful of how some parts of the physical examination and the psychiatric interview can be intimate and intimidating, particularly for a teenager in the presence of a parent."

"I was mindful of the fact that I am male, and she was female. Her mother was there, and you were present as a senior, female physician. Isn't that enough chaperones? Why don't people understand that we have to sometimes examine them and that we don't get any titillation from it?"

"The timing of your request was not very good, Sherlock. It's all about empathy. Phoebe was clearly very uncomfortable; the first thing we needed to do was to try to get her to talk to us at least a little bit, preferably without her mother. In my opinion, that required a new appointment in a better environment than here."

"I don't see the point of delaying. Maybe she wanted to talk but didn't want to do it in front of the mother, who should have been escorted out. Maybe Phoebe would have talked to us without her and let us examine her."

"Or, more likely, we would have a hell of a mess in our hands when the mother really did complain."

"Did you discharge her?"

"Yes, I did, with a follow-up plan at our youth outpatient clinic."

"She had a small fleck of dried blood on the edge of her skirt as though she'd been lifting it up at school to check if it was still bleeding, and dried blood under her fingertips. Anxiety makes people pick at scabs."

He knows this both because he's read so in the textbook chapters about obsessive-compulsive behaviour and because he does it, too. He can't abide the thought of things on his skin which don't belong there, hates scratchy and annoying fabric and sometimes, pain from something small helps him focus. He's never actively self-harmed beyond that, not really, but he thinks he understands the impulse. _Endorphins. Turning anxiety and confusing and frustrating things into real pain_.

"That may be, and screening for self-harm is a standard part of assessing young people with her symptoms."

Sherlock resists the urge to roll his eyes. "That's exactly what I was trying to do. Will the mother attend the outpatient clinic, too?"

"I'd say that's very likely."

"They'll get nowhere if they have to walk on eggshells; the girl won't talk if her mother is there. Why would she? It's obvious she walks all over her."

"Sherlock… You have to recognise that your approach hardly got us any further, and nearly decimated what rapport we'd established. We have to try to engage the patient's family in a positive way to avoid the whole process being derailed with conflict."

Is that what all those so-called professionals had been doing, ' _engaging the family in a positive way_ ', when they kept letting Violet Holmes speak for him, decide for him, walk all over him and put words in his mouth for years and years and years?

"People are so _irrational!_ " Sherlock snaps.

Alison offers him a piece of liquorice from a box on the table. They're allsorts, which he hates, so he declines. He doesn't want to think how many hands have dug into that bowl and contaminated the offerings.

"People are also fun, and interesting, and surprising, and for me, they're the best part of the job," Alison tells him.

Sherlock is looking at his knees. "For me, they're the _worst_ part of medicine."

She waits until he looks up again, worried about her continuing silence. "Let's see on Thursday if we can improve on that, shall we?"

He nods.

Alison helps herself to a treat from the bowl; one of those blue things which Mycroft always ate first from an allsorts bag. Sherlock would only accept the brown square ones, and he separated all the layers and only ate the non-liquorice parts.

He is alarmed to find that Alison is watching him thoughtfully.

"Look, I think that the lesson here has been learned. When I mention this to the Course Leader, I'll make a point that the matter has been dealt with and we've discussed it thoroughly. No need to make a mountain out of a molehill since the mother won't be filing anything formal. Nothing wrong with your intent, just the delivery. You'll learn."

This doesn't console Sherlock, especially since the expression now on Alison's face is one even he can read: she pities him. _Of course, she just wants to get rid of me; why would she want to get involved in the case of some student she thinks is useless?_

She's letting him off the hook, lowering the standards for him. Pity is worse than anger when it comes to being singled out. _Nobody is supposed to pity a doctor, are they?_

He is grateful that she lets him leave the room with no further conversation.


	6. Involuntary

  
"Today's topic is involuntary treatment and the associated bureaucracy. Not very exciting, I know, but it's very important that these things are done with strict accordance to the law. Patients have very sturdy rights to contest such decisions, so the paperwork has to be watertight. You'll be given two example cases which I'd like you to discuss within the group. Are the criteria for involuntary psychiatric treatment fulfilled in these cases, and what sort of a treatment plan would you propose?" Charles Chambers, the facilitator for the session, asks. He's a Registrar at the Peterborough psychiatric hospital, the Cavell Centre.

The practical clinical skills seminar is something that Sherlock is getting used to handling. For the next twenty minutes, he lets the others in the group take over when it comes to interpreting the fictional patients' symptoms and evaluating their social situations and support networks. Tasha Caines manages to shed her usual deference to everyone else in the group to make some sensible comments, which Wilkes then reinforces. Their growing relationship out of the classroom is becoming evident in their body language and behaviour in their work; they're becoming a mutual admiration society that Sherlock finds annoying.

When it comes to the precise wording of the law and the official processes of sectioning, Sherlock participates just enough that their instructor has no reason to jump in to make sure he engages. If he is very familiar with the rules and regulations about patient competence to make decisions regarding their mental health, it is something that the rest of the group has learned is his forte.

"Rote learning," Wilkes mutters, "…seems to be your _modus operandi_ , Holmes."

Sherlock does nothing to dispel their impression. In this case, his own experience of in-patient care at a rehab facility after he'd left Victor had been voluntary, but part of what he'd learned while undergoing treatment was that not everyone was there on the same basis. Perhaps the biggest take-home message of those six weeks as he'd struggled to get clean and be able to put the past behind him was that really wanting to change had been key to his recovery. Perhaps that is why involuntary admissions into acute psychiatric wards are something that makes him uneasy in principle _._ Can anyone actually force someone to engage with all this hocus pocus of psychiatry? Sherlock knows and accepts that there are patients who are unaware of their illness and cannot comply with life-saving treatment in the acute phase of their psychosis, but he can't help feeling unsettled by the notion of imprisoning someone simply because they refuse to engage with treatment that is being foisted on them without their consent.

Sherlock is glad when that days' group teaching session turns out not to include any mortifying team-building exercises. The rest of the week will be spent observing patient work and, with good timing regarding the topic of involuntary treatment, his and Sebastian's next placement is at a ward which handles such cases.  
  
  


_______________________________  
  


  
  
"Welcome to the Cavell Centre."

The psychiatric nurse who greets them has one of the deepest bass voices that Sherlock has ever heard. The man is about six foot three and close to a hundred kilos in weight. He's _enormous_ , and Sebastian gives him the classic up and down look before pasting on a smile that does little to hide his intimidation.

Nurse Jonas Jackson has a soft Jamaican accent with a veneer of South London which Sherlock can place as second generation, but someone with a strong maternal influence meaning the nurse wouldn't shed his heritage easily. If Sherlock's ability to recognise this fact about their mentor for today's clinical attachment is based on his time spent on the streets of London when living with Victor, it's not something that he's willing to share with Wilkes.

After five weeks of being paired with this idiot, Sherlock's patience has worn thin, very thin.

The fact that Wilkes had driven them from Cambridge to the Cavell Centre, on the outskirts of Peterborough, had been bad enough. The idiot had sneered at his suggestion that they take the train. "I have the loan of my father's car this week; it makes sense to use it since we can sleep much later."

The Cavell Centre is on the northwest outskirts of Peterborough, so the train and then bus would have doubled the travel time. By car, it was less than an hour, especially the way Wilkes drove. It's just that Sherlock doesn't care about sleeping late; he tends to wake up just after five in the morning like he's always done. And, as much as he hates commuter crowds on trains, he would much rather endure them than put up with what he thinks was rather a case of abuse of a vehicle rather than anything resembling normal driving, the way Wilkes handled it. _Too fast, with not enough attention being paid to what he was doing._

Wilkes had brought in coffee in a mug that slotted into the cupholder of the two-seater sports car. "Great for holding a beer," Wilkes had bragged.

The thought of someone so reckless drinking whilst driving was enough to make Sherlock check his seatbelt. _Needs must when the devil drives._ Sherlock now understood the old saying much better than he had ever hoped to.

As they had left Cambridge, Wilkes spent the first fifteen minutes on a monologue, bragging about how wonderful the Mazda MX5 was, the intricacies of the specifications, including tedious details about how the engine's electronic fuel injection system used a specially designed airflow meter and ignition system with an angle sensor instead of a distributor. Sherlock had tried to delete it all as soon as he heard it, slouched back in the bucket seat and closed his eyes, trying to ignore the fact that the upholstery smelled pungently of Revlon's Charlie, a perfume worn by Tasha Caines. It appeared that Wilkes' courtship had been successful. He wondered what bodily fluids might be in the seat upholstery, masked by the scent.

At the junction of the A14 and the A1, Sherlock had shoved his earbuds in and listened to his Walkman, thinking that if Wilkes had put half of the same attention to detail into his medical studies as he had into this automobile, he might actually have been a competent student. Unfortunately, the boy seemed more intent on testing the speed of the car on the motorway than of planning for today's session at the acute psychiatric ward. As they walked to the front entrance, Sherlock had made a decision to take the train back alone in the afternoon.

The psychiatric nurse peers at their student IDs — Sherlock suspects it's to verify their names match those the faculty had informed the unit would be the students attending the clinic on each day. "Holmes and Wilkes. Please follow me."

Jackson uses his badge, attached to a lanyard, to swipe them through the first set of electronically locked doors. "We're a low-security unit, but your badges won’t open anything; sorry about that, but you have to be escorted by one of the staff when you move around. The Cavell Centre has seven in-patient psychiatric units. You're assigned today to Poplar, which is a six-bed psychiatric intensive care unit for males over the age of eighteen who are exhibiting challenging or disturbing behaviour that cannot be managed on an open psychiatric ward."

Sherlock knows this means sectioned patients; some of the people here have been dragged in against their will. Even after all his reading, he finds the thought disturbing. _Wouldn't it be frightening to get dragged in against one's will when psychotic and having lost contact with reality?_

"They're not violent, are they?" Wilkes seems anxious, too.

Jackson's expression is patient; he must've heard the question before. "Most of our patients would more likely be at high risk of becoming _victims_ of violent crimes if they were out there unable to look after themselves than they'd be to commit them. Violence in psychiatric patients is most often reactive, not offensive. When psychotic, the world can be a very frightening place, and the help that a patient needs being forced on them can be traumatising. It still has to be done if they can't look after themselves or their illness puts them or others in danger. It's all very carefully legally regulated, though. Patients can contest involuntary treatment."

"Assuming they're in a fit state to understand the process," Sherlock pipes in. "Wouldn't the ones in the worst condition be most at risk for being mistreated, and also the ones least likely to start a complaint process?"

Jackson studies him for a moment, and a hint of irritation has appeared on his features. Sherlock scrambles to analyse what he's done to rile the man up. After the disaster with the self-harming teenager, he's been petrified about saying something that will land him in more hot water. He hasn't been summoned yet to a meeting with the Course Lead, but he's certain it will happen once Alison contacts them, and he doesn't want to add anything more to his list of failings.

Defensively, he adds, "I'm not insinuating that _this_ unit is mistreating people; all I meant is that there are potential loopholes in the legislation."

The nurse shrugs. "If no offence is given, then none is taken. It's not about the law so much as the practice. When patients start getting better, they tend to accept that they needed help, except for the ones who chronically lack self-awareness of their illness."

Wilkes yawns, straightening his jacket as though worried a patient might dare ruin his suit.

"You didn't really answer his question." Sherlock wants to know, even if persistence in his questioning might annoy the nurse.

Jonas stops walking and turns to look at both of them. "We do have some patients who are acutely very ill and because of that may not react very well to staff or students, but we have a solid safety culture here with practices that ensure the safety of all concerned. Statistics say it's much safer to work in a secure psychiatric unit than your average A&E. I should know; I spent two years working just that in Peterborough."

Jackson smiles reassuringly. "That was before I worked at Her Majesty's Prison Whitemoor, just down the road from here. Gave me insight into the forensic side of mental health. Compared to those places, the Poplar Ward is a haven of peace and tranquillity."

He swipes them through another set of locked doors, and continues, "I'm to take you to an intake interview with our unit's consultant, and you'll also get to attend some patient conferences where we decide whether to continue involuntary treatment and whether patients should be discharged from here or transferred to other units."

The nurse leads them to another corridor which opens to a staff working area on the right. Down the hallway, Sherlock can see a set of doors, each with a swipe box. Nurse Jackson opens a locked drawer on the side of the desk. "Right. Give me your phones, wallets, pens. Pencils, notebooks, whatever… They'll be stored in here for the duration."

"Why?" On this occasion, both Sherlock and Sebastian ask the question almost simultaneously.

"Because we don't let the patients have those things, so staff don't get them either. No need to tempt anyone into thieving or pocketing something that could be used as a weapon or to harm themselves."

While Sherlock is emptying his pockets, Sebastian asks, "Anyone in here attacked any staff lately, then?"

Jackson sighs. "We care about the welfare of our patients _and_ our staff. No need to run any risks; we do our best to avoid any escalation, and confiscating such things sends a solid message. The consultant will explain more about our procedures."

Wilkes spots a coffee machine on the counter behind the desk. "Mind if I grab a cup?"

"Help yourself; it's decent stuff. Doctor Zephaniyah will be in shortly."

While Wilkes pours himself his — at least — second coffee of the day, Sherlock loiters; he doesn't need caffeine to add to his anxiety levels. He peers into the consulting room across the corridor; the door is open, so he sticks his head in to get the lay of the land. The constant change of environment as they get shuttled from one facility to another takes more energy for Sherlock to handle than the average medical student. This psychiatry and mental health course is the worst of them all; the others have been hospital-based or at GP surgeries, which gives him some sense of familiarity on which to rely.

The consulting room is big enough to have two folding chairs against either side of the wall that has the door into the room. In the middle are two more comfortable swivel chairs with about a meter and a half between them. While the furniture looks relatively comfortable and ordinary, Sherlock spots that the swivel chairs are actually bolted to the floor, presumably to protect the medical staff from someone who might become violent trying to use a chair as a weapon. The set-up is depressingly familiar, and a memory crawls out of a dark place he'd hidden it, reminding him of one of the rooms he'd been in while in rehab after he'd left Victor behind. The private clinic in France which Mycroft had arranged had given him some privileges because he'd been cooperative, but some of the patients there had been sectioned, and their behaviour had been in marked contrast to his own. Sherlock had been as motivated to get clean and sort himself out so he could get into medical school as he was to leave the place behind. He'd spent five weeks trying to keep out of trouble and off anyone's radar, knowing that social interaction was not his forte. He has always suspected that Mycroft had picked the place to provide a warning as well as expert help. This ward brings back too many old memories that Sherlock would prefer to forget forever.

"Why do they ask us to get to places so early if all we're going to do is sit around waiting?" Wilkes grumbles.

Sherlock shrugs. Doctors in both hospital and outpatient units tend to be late because their workloads are heavy. Sherlock prefers to be early so he can familiarise himself with the surroundings rather than just saunter in and instantly know how to behave, as Wilkes seems able to do. How is it that the harder he tries, the more out of place he feels and also imagines he acts, whereas Wilkes can just… Sherlock knows it's about confidence and about putting others at ease, and bitterly envies Sebastian for such gifts so unfairly bestowed upon such an idiot.

Finally, behind him, he hears the arrival of someone and turns around to see a rather nondescript middle-aged white man wearing casual clothes — a pair of rather worn tan chino trousers and a rumpled blue blazer over a yellow polo shirt.

"You're one of the medical students, I presume?" He asks.

"Yes, Sherlock Holmes." He's confused by the man's clothing; is he a patient?

Sensing his discomfort, the man introduces himself. "I'm Joshua Zephaniyah, consulting Psychiatrist on the Poplar Ward."

"Oh."

His reaction seems to amuse Zephaniyah if the man's facial expression can be trusted. "You seem surprised, Mister Holmes. Do I fail to live up to your image of what a consultant should look like?"

Embarrassed by somehow telegraphing his confusion, Sherlock can only nod, and then suppress a grimace as he processes what he's just confirmed to the man. How was he supposed to know the consultant? He wasn't wearing a white coat or scrubs, had no name badge, no lanyard. With none of the official accoutrements of a medical professional, the man could have been anyone.

Fortunately, Zephaniyah doesn't look insulted. He laughs, instead, just as Sebastian makes his way over to them.

Shifting the coffee into his left hand, Wilkes extends his right hand to shake that of the consultant, enthusing: "Doctor Zephaniyah, so pleased to meet you. I read your article on the differential diagnosis of schizophrenia versus borderline personality disorder — fascinating."

 _Crawler._ Sherlock watches Wilkes sucking up to the consultant, who beams at the student. Leave it to Sebastian to neglect all of the theoretical textbook preparation but still manage to squeeze in a bit of buttering-up material.

Zephaniyah leads the way into the consulting room, pointing them to the folding chairs. "Those are yours. Keep seated at all times, and quiet unless I direct you to participate. You are here mostly just to observe this morning." His tone is a bit stern. "Once you understand the way things are done here, then maybe this afternoon, you can get more involved. This is an acute patient ward. Most of the six patients here have serious psychiatric problems which result in behaviours that make them difficult to accommodate in an open, voluntary environment."

Wilkes has unfolded his chair with ease and put his coffee cup on the floor while Sherlock is still struggling to get his open and latched into the proper position. He feels all thumbs and awkwardness, feeling the consultant's watching gaze. Finally, he gets seated and holds his hands in his lap. Without a pen or notebook to occupy them in a camouflaged way, he knows he will have to concentrate on keeping them from betraying his anxieties. Too many memories of being in exactly this sort of consultation keep seeping into his consciousness, raising his pulse and making a thin trickle of sweat run down his back under his jacket.

"Mister Holmes, you were surprised by my attire. I can assure you that here in the ward, we dress in this way so that our patients feel less threatened. Many of them have had difficult therapeutic experiences, and we try our best to avoid worrying them. Part of that means not using medical clothing or other symbols like name badges that would give us a status which could be seen as domineering."

Sherlock is intrigued. At his rehab clinic, the medical staff had gone out of their way to differentiate themselves; uniforms, badges, clipboards—all the accoutrements needed to establish their power differential and keep the patients firmly at bay. It has never occurred to him that there would be such differences in approach. Leaning forward, elbows on his knees, Sherlock asks, "How much leeway do you have when it comes to therapeutic philosophy?"

Doctor Zephaniyah smiles, "More than you would think. Every Trust has a surprising amount of freedom, and even between different facilities within the same NHS area, there can be different approaches. This helps patients find the regime that suits them best. Here at Poplar, we're small enough to deliver patient-centred care, with treatment plans that are tailored to each individual. Speaking of individuals, our intake patient will be here soon, so let me brief you. Billy Kincaid has been here before, so he will know how things work. He's been diagnosed as schizophrenic. What can either of you tell me about that condition, and what might we expect has led him to admission here?"

Sherlock jumps in before Wilkes can even draw breath. "According to DSM-IV, he will have two or more of the following characteristic symptoms: third person auditory delusions, hallucinations, disorganised speech, grossly disorganised or catatonic behaviour, negative symptoms such as affective flattening, alogia or avolition. These will have led to societal or occupational dysfunction, making work, interpersonal relations and self-care fall below norms before the episode."

The consultant nods. "Textbook answer, Mister Holmes. Mister Wilkes, what additional insights does the ICD version offer?"

Sebastian shifts in the chair, making it squeak in protest. "Um… there can be withdrawal and thought passivity… and…uh, running commentary by the voices in his head."

"Amongst other things, yes." This is said rather dryly. "What do the two diagnostic systems have to say about duration?"

Wilkes answers this more confidently, "At least one month."

Sherlock shakes his head, "Yes, but DSM-IV specifies that month takes place within a six-month period when the symptoms can recede or increase but must still persist to some degree."

Wilkes shoots him a glare, which Zephaniyah notices. "It's not a competition, gentlemen. What would make this patient someone who needed to be here, instead of a general ward or managed in the community?"

Sebastian answers, "Being violent? His behaviour means he is unable to interact with the other patients?"

"Anything to add to that, Mister Holmes?"

Sherlock leans back in his chair and crosses his arms, a frown forming on his face. "Lack of insight and consequent inability to look after his own safety and well-being. As for what it is specifically for Billy Kincaid, I couldn't answer that until I've seen the patient. It wouldn't be fair to prejudge. Is he sectioned? Or was it voluntary? What is the patient's history on the wards here? You said he'd been here before, but even so, that doesn't mean he's here for the same reason he was on the ward before."

That brings a smile. "Well done, Mister Holmes. It is important not to jump to conclusions. It is a capital mistake to theorise before you have all the data. Invariably, you end up twisting facts to suit theories, instead of theories to suit facts. Mister Jackson…" the consultant raises his voice so that the nurse outside can hear, "Bring Mister Kincaid in, please."

The intake interview is surprising _._ Doctor Zephaniyah greets the patient casually almost like a friend, even to the point of using humour about him liking Poplar so much that he's put himself back here for the third time in four months. Kincaid is sporting a black eye, and his knuckles show signs of damage. When Zephaniyah asks him if his injuries are bothering him, Kincaid cracks a smile and says bullishly "You should see the other guy; got him with a shoelace as a garrotte."

The consultant does not probe into the fight that must be the reason for the patient's return. It seems distinctly odd to Sherlock that the doctor's attitude is not one of judgment and criticism; surely a patient whose behaviour on an open ward had been disruptive and difficult should have those issues addressed at the very start? How can a patient be expected to get better if he isn't told what is needed to conform to expectations? Yet there seems an almost cursory discussion of the treatment plan and what is needed to adhere to it.

Kincaid's manner is ebullient; he is no way intimidated by being assigned to the acute ward rather than the general one. "Food's better here; no idiots to get in my way."

Wilkes is leaning against the back of his chair, slouched almost to the point of rudeness, not really focusing on the conversation between the patient and the consultant. Sherlock is usually annoyed by Wilkes, but today it seems to be worse than usual. For once, they're dealing with a severe psychiatric illness with a well-established brain neurochemical imbalance and genetics rather than something vague. He tries to ignore the idiot but finds it hard to sit still. Without a pen and paper to hide behind, he has nothing to occupy his hands and ends up stuffing them under his thighs, lest they escape to stim too obviously. He'd already caught himself from rubbing the side of his index finger with his thumb, something he often does when reading a textbook.

Kincaid is ignoring the two students completely, focusing instead on the consultant, responding in a manner that Sherlock realises is almost charming. He sounds _glad_ to be in the ward. Still, there's a tenseness in him, like a coiled spring, and the atmosphere in the room is expectant and anything but relaxed.

When the interview is finished, and Kincaid is taken by Nurse Jackson to his room, the consultant turns to them. "Mister Wilkes, have you any observations about that interview that you'd like to share?"

Wilkes sits up straighter in the chair, nods, and says, "I was most impressed, Doctor, at how you helped him relax and deal constructively with his move here. It was almost a case of setting up his sectioning as a sort of 'time out', during which he can address the reasons why he's been struggling with an open ward."

Sherlock lifts his glance from the patient's detailed file, resisting the temptation to roll his eyes. Wilkes never misses an opportunity to suck up to the clinical physicians, finding ever more extravagant ways to stroke their egos.

"Mister Holmes, you don't seem to share that view. What did you observe?"

Without thinking, Sherlock answers, "A patient who is repeatedly failing to address the issues that have led to his sectioning in the first place. I'm surprised that you didn't subject him to a Brief Psychiatric Rating Scale to check on his symptoms, and that you did not discuss his past aggressive behaviour in the wards or attempt to assess the most recent behaviours using the Overt Aggression Scale. The timing of his most violent outbursts has always coincided with the discharge phase, not when he's been brought in suffering from acute psychosis. The garroting attempt, in particular, seemed too organised and planned to be a spontaneous, reactive act." Sherlock taps the file in his lap. "He has been here at Cavell for eight weeks and receiving pharmacological support to moderate his schizophrenia, yet the CBT to try to get him to address his anger management has clearly not worked. I am surprised that no one seems to be willing to address a possible root cause."

Zephaniyah's eyebrows rise up his forehead in surprise. "Pray tell, what do you think the root cause is that everyone, myself included, seems to have missed?"

 _In for a penny, in for a pound_ , as the saying goes. Sherlock draws breath and then pronounces, "Kincaid is obviously a patient who perpetuates verbal and physical aggression both in the community and during hospitalisation, yet he didn't mention any upsurge in severe thought disturbances that might result in higher levels of hostility and suspiciousness. As you said, the general ward monitoring of his levels of paranoia and auditory hallucinations were unable to predict the outburst that ended up with him being confined here rather than on a general ward. That begs the question of whether it is a learned, conditioned behaviour to get what he wants or a true extenuation of his psychosis. This is the possibility you didn't probe."

Zephaniyah's eyes widen. "Mister Holmes, have you considered _why_ I might have chosen not to do the things that you've just described?"

Sherlock shrugs; he is truly mystified.

The consultant answers his own question. "Billy Kincaid has a long history of violent behaviour. That won't change until he learns how to handle the anger and frustration that lead to those outbursts. What purpose is served by reminding him of that fact without helping him understand why it is happening, and what he might be able to do to control it? We need to establish rapport, to create a safe space so that he might open up a little, accept a therapeutic approach. An intake interview is not the right time or place for the kind of probing you suggest."

Sherlock is perplexed. These things should have been raised in the CBT sessions, and yet obviously, no progress was being made there. With three week-long stays in the Poplar Ward in his three-months so far at Cavell, the patient seems to be playing the system. "Clearly, it's not the schizophrenia that is making him act violently. Have you considered the possibility of comorbidity of psychopathy? He may be using violence as a way of improving his living conditions."

Once again, the consultant's eyebrows crawl up his forehead, and Sherlock hears a derisory snort from Wilkes. "On what do you base such a conclusion?"

"The prison tattoo on his left wrist, above the scars of self-harming that are approximately four months old. If I am not mistaken, he was an admission from HM Whitemoor prison?"

"What of it? It is estimated that between thirty and forty per cent of the prison population in the UK has mental health issues."

"Given conditions in prison, a general ward here at Cavell would be a considerable improvement. The single room and one-on-one treatment here at the Poplar Ward would be like a hotel to someone who has been in prison. The timing of his outbursts in the general ward seems remarkably convenient; have you considered that he may be using his mental health issues to ride out the bulk of his prison term in relative comfort? That is psychopathic behaviour, and perhaps he's _banking_ on the fact that you'd chalk it up to his schizophrenia."

Zephaniyah shakes his head. "You made an interesting start by not wanting to judge the patient before seeing him, yet on the basis of observing one interview and a glance at his file you seem to want to label him as a malingering psychopath. This is not how psychiatry proceeds, Mister Holmes. If we cannot win the trust of our patients if we cannot learn to empathise and see the world through their eyes, how can we expect them to respond to our proposed treatment? This is not surgery. It isn't a case of identifying a problem and resecting it. We're not prosecutors or judges, either. One cannot remove the experiences that brought a person like Billy Kincaid to this place. We can only help the patient heal themselves, and we can't push them away because their underlying problems cause them to break the law or make us uncomfortable."

 _Some people voluntarily choose that as a job; thank God I won't have to._ "I prefer surgery," Sherlock mutters, and Wilkes laughs.

The consultant gets up. "We have other patients to help, Mister Holmes if you can be bothered to consider that as something worthwhile."

Even Sherlock can read on the man that he's disappointed and vexed.

The rest of the day, Sherlock stays as quiet as he possibly can, and the next in-patient appointment they attend goes without trouble. They have an intake interview with Andy, a seventy-two-year-old paranoid schizophrenic who had stopped taking his medications.

He doesn't make eye contact; mostly, he just fingers a lock of long, matted hair compulsively and repeats: "I don't know why it wants to be doing that". When Doctor Zephaniyah manages to coax forth an answer, it's a hum or a coherent set of words which don't seem to have anything to do with the content of the inquiry. He doesn't seem agitated, just small and frightened, and Sherlock thinks being dragged into such unfamiliar surroundings can't help. _When you're in acute psychosis and refuse to get help, there truly are people out to get you._

The appointment is short; it doesn't take much time to establish Andy is in need of urgent treatment and cannot consent or understand what is happening to him.

"He's been in and out of sectioning for twenty years," Doctor Zephaniyah explains after he had been escorted out of the room. "It's a wonder nothing's happened to him when he starts wandering around. He lives alone in a dilapidated farm he inherited from his parents, so treatment compliance is challenging even with regular visits from the local Home Care Team. When he stops letting them in is usually the first sign that things have gone wrong. We try to intervene early, but this time, he wandered off before the Community Care Team was able to talk to him. He used to keep sheep and chickens, but the animals had to be taken away because he couldn't look after them. During the last visits, when he let the Care Team in, he insisted the animals were still there, that he could hear them all the time."

"Shouldn't he be in an institution?" Wilkes inquires, and for once, Sherlock could have asked the same.

"We don't have a whole lot of those left. It's all about care in the community, now," the psychiatrist explains, frustrated. "If there only _was_ a community. These ideals are based on old models where the mentally ill were cared for and accepted by their social groups. Even in smaller villages, now, people like Andy live very isolated lives. He's been here several times, and usually, he improves very swiftly once his medication regime is re-established. We may have to consider long-lasting injections for his future, I think."

"I thought it was just bipolar patients who tend to go off their meds," Wilkes comments.

"Wouldn't an increasing frequency of auditory hallucinations suggest non-adherence to treatment in paranoid schizophrenics?" Sherlock pipes in, rolling his eyes at Wilkes' idiocy.

"That's right. Hallucinations may or may not be connected to patients' life events and surroundings, and paranoia can be directed at anything and everything from specific people to society at large. A sense of everyone being after you, wanting you dead is fairly common."

"I would assume people would be queuing up to get treatment if they heard voices. Don't they know they're not there?" Wilkes asks.

"When acutely ill, they cannot really tell the difference. By definition, psychosis is a disconnection between reality and the patient's perception of it. However, when their symptoms are well-managed, many do recognise which things are real and which sounds are auditory hallucinations."

"So it's now known what, or who, Andy usually hears?" Sherlock asks.

"Are they typically specific people?" Wilkes adds. "You said that they could be anything."

"Yes and no," Doctor Zephaniyah says. "I cannot offer you statistics, but only sometimes do patients hear a familiar voice. Mostly, it's generic, but it's the same one. Many have several, and there can be other sounds besides voices. Banging, the sound of water, for instance. Hearing one's name being called or voices mocking the patient or describing them as worthless seem to be very common. These are things most people occasionally think about themselves, I suppose, but in the brains of psychotic individuals, those thoughts evolve into a life of their own. Andy usually hears only one — a young girl, and that's all he has ever been willing to tell us. Oh, he has stressed that the girl doesn't tell him to hurt anyone. He's been very clear about that. He wanders out of the house when the girl tells him to go walkabout."

"It's a bit like those people who think they've been abducted by aliens, isn't it," Wilkes chuckles. "Thinking they have implants in their heads and that they're getting orders from somewhere."

To Sherlock, this doesn't seem like a very clinically relevant comment, just dismissive chitchat, but Doctor Zephaniyah seems to lap it up. Sherlock curses inwardly; he never attempts humour these days because either his topic or his timing will always be off. He doesn't know how to entertain people, to get them to like him, to create a relaxed atmosphere. People get tense around him, and then they leave.

"I've always found it fascinating," the psychiatrist starts, "what things a patient's mind latches onto as it slips into psychosis. There are logical connections such as a religious person developing delusions connected to that — I've met two who believed they were Jesus or an apostle reincarnated under acute psychosis. Supernatural beliefs and beings are not unheard of as features of psychosis, though I've yet to meet someone who thinks aliens are visiting them. Patients with dementia may keep forgetting who has visited them recently, so they become paranoid about people coming into their home uninvited. But often, like we just talked about, patients hear the voices of imaginary people, and sometimes those voices tell them to do very uncharacteristic things. The violent commands are something patients often resist very firmly, and they're often the most anxiety-provoking."

"So, patients have arguments with their voices?" Wilkes asks.

The psychiatrist smiles. "Oh, yes. Ever seen people out in cities talking to themselves quite animatedly?"

The students nod.

"Well, that's what you may have been observing. When doing well, many patients can ignore the voices, tell them to leave, argue with them, reason with them. But they're still there. Suicide rates for schizophrenics are high, and it can be both the positive and the negative symptom clusters which deteriorate their quality of life."

From his reading, Sherlock knows that, in this context, 'positive' doesn't mean good, but refers to symptoms which _start_ happening during acute symptoms instead of negative symptoms which, by definition, _stop_ happening.

"Can you tell me which positive symptoms we may have just seen Andy presenting with?" Doctor Zephaniyah asks.

Wilkes crunches up his disposable coffee cup and says nothing.

Sherlock suspects he hasn't studied enough on the topic to answer and takes the chance to answer. "Positive symptoms can include paranoia, hallucinations auditory, olfactory, gustatory or tactile or rarely visual, delusions, confused thoughts and disorganised speech, trouble concentrating and movement disorders. Andy was fingering his hair, couldn't stay on topic, seemed confused and intimidated, repeated things. He didn't answer questions about the voices or paranoid ideation, but we know from his history that those things may well be there."

"Good. Now, Sebastian, would you consider him to be fit for voluntary in-patient treatment at this point?"

"He can't obviously give consent, and if he keeps stopping taking his meds, clearly that decision has to be taken away from him, and until he's better, he should be kept here."

Wilkes makes it sound like punishment. _Andy is ill, not a criminal._ It's not the first time that Sherlock has picked up on the fact that Wilkes doesn't seem to think people with psychiatric disorders are anything like him, even if literally anyone could be afflicted by such troubles after experiencing enough stress or trauma. _That's what research says, anyway._

Sherlock has seen this before — doctors and medical students behaving as though the problems their patients suffer from — be those physical or mental — are beneath them and could never happen to them. Is it a self-protective instinct to separate them from the frightening reality that illness and infirmity really could strike anyone, and that one day they might have to adopt the role of a patient?  
  



	7. A Threat To Others

The last patient interview of the afternoon turns out to be more problematic. 

Zephaniyah seems tired and is a bit abrupt with his briefing. "Stephen Jones is a nineteen-year-old schizophrenic patient who is refusing to adhere to the treatment plan. He went off his meds and was readmitted a week ago under a sectioning order due to suicidal ideation. He's been unemployed since leaving school at sixteen, had been abusing drugs. He'd been through a rehab course but, by his own admission, is in danger of relapse. The assessment by the Peterborough community team has led to his re-admission here."

The psychiatrist hands over the treatment notes to the two students. "I want you two to discuss with him his reasons for non-compliance with the original treatment plan, and to propose a revised one. Please work _together_ if that is possible."

 _Chance would be a fine thing._ Sherlock wonders if the man's pointed tone means that he's picked up on the fact that there's no love lost between the two. The idea of working with Wilkes on a case like this and coming to the same conclusions, in front of the patient, is ridiculous.

In the case notes, Sherlock is disturbed to see that the patient had tried suicide by overdose, saved only by the intervention of a local hostel worker.

After they've read through the file, the consultant moves from his usual chair, pointing at the pair of bolted chairs. "You two sit there." As they do, he takes one of the folding chairs and sets it about a meter and half away from them, in the middle. "I'll be back here, making sure things don't get out of hand."

Stephen is a tall, skinny youth, dressed in a grey long-sleeved t-shirt and joggers, which make him look even younger. He has the grey, pasty complexion of someone with a drug problem. He slumps into the chair as Doctor Zephaniyah introduces them.

Perhaps because he has already been chastised for making assumptions, Sherlock lets Sebastian start the questioning.

"Mister Jones, can you tell us why you think you've been brought into this ward?"

Sherlock has to refrain from rolling his eyes. The sectioning had been done more than a week ago. _What's the point of rehearsing it now? Wilkes asks such pointless questions._

Stephen doesn't look at Wilkes, but mutters, "Sectioned; yeah, bloody obvious." He's tapping his index finger against his thigh in an odd sort of rhythm.

Wilkes looks pointedly at Sherlock as if to say it's his turn.

"Mister Jones, what are the voices you are hearing saying to you right now?" Sherlock asks.

That gets a weird kind of laugh. "They're saying you're both a couple of numpties."

Sherlock can't tell if he's joking. "Have the voices been the reason why you don't stick to the treatment plan?"

"Yeah, you could say that. They know better than all you doctors." Jones ramps up the drumming on his thigh, letting his right and left hands get in on the act.

"Do you like the voices?"

Steven smirks. "Yeah, only friends I got. Dunno why everyone's so insistent that I should kick them out."

"Do they ever get you into trouble, give you bad ideas?" Wilkes asks.

The patient shrugs, purses his lips.

Wilkes sits forward, "I understand from your notes that you have family in Cardiff. Have you considered getting their support to help you stick with the treatment?"

"Like that's gonna happen. Me mam kicked me out when I started using; the bloke she's shacked up with don't want the likes of me around. I'm on me own. Well, me and me voices. Always got company, thanks to them."

"You're using a plural. Are they all agreeable, or…?" Sherlock asks.

"What?" Jones demands. "Speak bloody English."

"You said _voices_. There's more than one, then?" Sherlock presses.

"Yeah."

"Do you know them?"

"'Course I know them; I've had them since forever!" Jones' voice goes up in pitch, and his shoulders tuck back.

"Forgive our curiosity," Doctor Zephaniyah says pleasantly, "these students have not studied psychiatry before, and talking to patients about them symptoms is very useful in learning about these things."

 _'These things' — euphemisms and soft phrases designed to circle around what is really going on._ Sherlock can understand why they're used, but it still irritates him. It's precisely the way that therapists and other healthcare professionals always talked to him even when he was in his late teens and could understand perfectly well the proper terminology they used with his mother.

The psychiatrist's apology seemed to have done the trick, and Jones leans back in his chair. "What do you wanna know, then?" He asks.

Sherlock wonders if the patient has sensed an opportunity to get the upper hand by playing teacher." You seem coherent and aware of your symptoms. Yet, you're sectioned, and it's not the first time. Why is that?"

"Ask them idiot lot." Jones cocks his head towards Zephaniyah. " _'Coherent_ ', eh? You're a posh bloke. Doctors pretty much always are."

"Do you have something against educated people?"

Jones is staring at him intently. "Posh ain't the same as educated. I've met some educated people like me sister, and they're nothin like you. You can read every bloody book in the library and still be a pretentious, poncey idiot. Pretentious, now there's a good word for ya."

Sherlock couldn't agree more that even academia is infested with stupid people, though he detests being clumped together with these 'educated idiots' Jones hates. "You didn't answer my question."

"Maybe I'm not interested in answering you."

Wilkes gives Sherlock a knowing sideways glance, and then that smarmy smile comes out. "So, you're refusing treatment because you like the voices? You said as much, that they keep you company. Surely, you can see that not taking your medications keeps landing you back here."

"This ain't too bad. Better than prison."

"Well, you could avoid both," Wilkes says a bit pointedly.

"I ain't got a pile of daddy's money like you probably do. I gotta eat. Not a lot of jobs available for someone with my history. You should see their faces at the jobcentre if I show up and tell them I want to get hired for somethin'."

"Do you take drugs to control the voices?" Wilkes asks. "Or why do you––"

Jones looks very unimpressed with him. "No, I don't; not anymore. But they'd be better than the meds, I can tell ya. That shit turns me into the livin' dead. That's no life."

The file had shown that he was being given injections of antipsychotics since he refused tablets. He'd been in treatment for two weeks, now, which explained his coherent speech and relatively communicative mood.

Sherlock realises it's his turn for a question and decides to explore motivation. Theory says it's one of the key parts of getting a patient to commit to getting better. "Treatment plans are sometimes generic solutions that don't always fit a person's circumstances. What do you think of your treatment plan?"

"I don't even know what that plan is, and it's got to be a load of shite if it's the same they've been trying forever. Never goin work, not with me."

Sherlock follows up with another question before Jones can continue his rant. "If you could imagine yourself in a better situation, what would it be?"

"A room of me own, plenty to eat, no need to scrape around for odd jobs I keep gettin' sacked from, no need to stand in a queue every week begging for the dole and me benefits. Not havin' to talk to hospital idiots. Warm, safe — just me and my voices. Maybe with some nice bird to keep me company. Yeah, that would work for me."

Sherlock can already appreciate the challenges of Jones' case. If the patient didn't see it as a tragedy to end up at a closed ward because it was 'at least better than prison', if he saw no benefit in adhering to treatment… One of their lecturers had said that there are many patients who need to be protected when psychiatrically ill, and then there is the rare patient from whom society needs to be protected. The statistics show just what Doctor Zephaniyah and Nurse Jackson had said — that schizophrenics are a marginalised bunch more likely to be victims of violent crimes than being the perpetrators of such. But, what to do about those patients who did have a mental illness, but who were also prone to violent, unsocial behaviour or who refused to work together with healthcare professionals on principle?

Violence is the realm of forensic psychiatry, but once in _that_ system, patients have already done something criminal. _Jones really is right, isn't he, in that being here was better than prison_ , Sherlock muses. _Maybe he can only see incarceration or institutionalisation as a logical endpoint of his life, and thus sees no incentive in trying to control his violent impulses?_

"Do you prefer being in here to being on the streets?" Sherlock asks.

"Like, duh… that should be a no-brainer, even if a bloke like you couldn't possibly imagine that it's like out there. I ain't going back to that jobcentre if I can help it."

After hanging out in some pretty dodgy crowd when he was still with Victor and teetering at the edge of homelessness, Sherlock knows more about what it's like than he wants to. Of course, he doesn't say this out loud. "So, is that why you threatened to kill yourself? To be sure of getting back in here?"

Jones looks at the floor. "Can't say that, can I? Have to show _intent_ , the word they like in 'ere." He pushes the long sleeve of his T-shirt up and turns his left wrist over.

Even at this distance, Sherlock can see a thin, red scar — a slice across the wrist, but not one deep enough to really threaten to end his life. _Is it so shallow because he didn't know how to do it properly, or because he didn't really want to die?_

Sherlock nods, watching Stephen intently. "As they say, suicidal ideation is really a cry for help. But saying you were thinking about it probably wasn't enough to convince your community caseworker. Is that when you decided to cut yourself? Was it a voice that told you to do this so you could get off the streets?"

Jones shakes his head, angry now. "You saying I didn't mean it? It's fuckin' frightenin' out there, would be for anyone. It's no good, and it sure as hell isn't making me better. What right have you to judge me, you poncey git?"

Zephaniyah stirs from his seat but keeps quiet.

"We're not judging, just trying underst––" Wilkes starts meekly, but Sherlock isn't done.

He can't decide if the patient could be as calculating as he now suspects, or if it's just the frustration and impulsivity brought on by his badly managed illness that makes him act out. "Is your desire to get back into the hospital what drives you to non-compliance and violence?" He asks, rapid-fire, interrupting Wilkes.

Jones turns to look back at the consultant, suspiciously. "Am I being set up here? You trying to get me turfed out?"

"Mister Jones, I can assure you that no one is questioning your need to be here," Zephaniyah says in a tone that is clearly trying to mollify the patient's anxiety.

" _He is!_ " Jones points his forefinger at Sherlock; a gesture intended to threaten.

Wilkes seems paralysed by the escalating tension; sitting back in his chair, he shakes his head, a gesture which Sherlock finds a bit confusing and rather more condescending than he'd like.

Sherlock tries again. "Mister Jones, the diagnosis that put you into the general ward was based on self-harm. The file says your move here to Poplar was based on a fight in the Maple ward. That's about harming others, not yourself. Can you tell me something about that fight?"

Jones' moves his hands out of his lap, rubbing them together. He puts both feet on the floor, abandoning the nonchalance of his previous slouched posture. "Whadda you wanna know for?"

"It could explain a lot about the motivation behind your behaviour and its triggers," Sherlock explains.

Jones gets twitchy in his seat, shifting his weight around on the folding chair. "Motive? You want a _motive_? Sounds like I'm back in court, and you're the prosecutor." He's breathing faster now, showing signs that Sherlock interprets as revealing that they are getting to the heart of the man's problems. "I'm not some nutjob. I do what I need to do."

Sherlock perseveres. "So, you're saying that the voices have never been the cause of why things go wrong for you? Are you truly in control all the time as you claim? Or, did the voices keep telling you to start the fight?"

An angry scowl erupts on Jones' face, which is turning red. Suddenly, he stands up, grabs the folding chair he's just vacated and throws it, legs first, straight at Sherlock. _"Hell yeah, they did!"_

It all happens so quickly there is no time for Sherlock to take evasive action. An instinctive duck and his raised right hand might have deflected the chair legs from injuring his eyes, but one of them smacks into the side of his head with enough force to knock him off his seat. His vision blurs and doubles, but he can see that Wilkes is out of his seat as well, now backed up against the side wall with his hands up.

Simultaneously, Zephaniyah shoves a hand into his pocket, likely to press an alarm button, and yells: " _JACKSON — Code A!"_

The big nurse charges into the room and grabs Jones from behind, pinioning his arms and lifting him off the ground. The patient starts shouting and screaming.

Wilkes is gaping in the corner to which he's retreated. It takes a moment for Sherlock to recognise that Zephaniyah has appeared at his side and is talking at him. He trails his hand up his cheek, then looks at his fingers, blinking when he sees red. His forehead must be bleeding.

The commotion is over as quickly as it had begun; Jones has been dragged outside, and Wilkes is now standing in front of Sherlock as well, offering a tissue he's pulled from a receptacle in the wall.

Sherlock accepts it, still not quite registering what had just transpired.

The consultant reaches a hand up to shift his hair, and Sherlock flinches; it takes a moment for him to connect that he's checking out the wound. "It's a small scratch and will probably bruise; the Ward Sister's office has supplies we can clean that with. Are you all right?"

"What kind of a question is that?" Wilkes asks indignantly. "He was just _assaulted_ ; of course, we're not alright!"

Sherlock doubts the man is really angry on his behalf — just shaken because it could have been him. _'We', indeed._

Sherlock wonders what had tipped Jones over the edge and whether he had been wired for a fight from the start. _Perhaps he is always that way_. What had been the question Sherlock shouldn't have voiced? In most cases, when he does something wrong socially, there isn't one obvious thing he's missed or done wrong, but now, surely there is an answer to be found this time?

"Is it because he doesn't want to admit the voices make him do things? Would admitting to that mean admitting that he's ill? Isn't that what he wants? To have a reason to be back here instead of on the streets?" Sherlock asks, and his voice sounds distant to his ears. "How do you confront a patient without really confronting them?"

Doctor Zephaniyah shakes his head. "Let's not think about Stephen Jones now. We need to find Mrs Hall, the Ward Sister, and her first aid kit."

  
______________  
  


By the time they get to leave, Sherlock follows Wilkes back to the car for the journey home. A pounding headache had developed during the remains of the afternoon, and it had made him revise his original travel plans of going back by train. It had taken an hour for the nurse to fuss about his injury, and for a report to be made to the faculty about the incident. Zephaniyah had insisted one be made, but at least he'd not pushed the issue when Sherlock had insisted that he didn't need to get checked out at A&E, nor did he need an appointment at his GP, or a debriefing, or anything else reeking of counselling.

He'd pushed Jones, and the man had cracked. Like always, he'd said too much or too little and got punished for it. Why would he need counselling about something which was a regular feature of his life: failing to deal with other people? It's not the first time someone has objected to him and resorted to violence. He'd had enough of that in school to know it won't be the last, either.

Driving out of Peterborough, Wilkes is muttering angrily about lacklustre safety measures and has a few choice, derogatory words about patients such as the ones they'd encountered today. "Nutcases; the whole lot of them. Care in the Community? What stupidity. If I had my way, they'd all be locked up — that's what's needed."

"How enlightened of you, Wilkes," Sherlock mutters. It's not fair to lump all these patients together. For some of them, the biggest problem is the lack of availability of suitable care.

"Better than you, Holmes. I mean, the guy was asking for trouble, so why the hell did you go for your usual tactless, stupid questions to push him over the edge?" Sebastian asks as he takes the car down the ramp onto the highway back to Cambridge.

"Let it go. My head hurts enough without having to talk to you."

Wilkes snorts, and then snaps unsympathetically, "You _really_ aren't cut out for this, are you, Holmes? And if that wasn't enough, you don't even see it, do you?"

Sherlock doesn't deign to reply. For the rest of the journey, Sherlock tries to tune him out, mostly successfully.

He knows that Wilkes' attitude problem is part Wilkes, part symptomatic of one thing he finds particularly distasteful about psychiatry: there is always a need for doctors to establish a diagnosis so that the proper treatment regime can be initiated, but that seems to require ignoring patients' personalities in lieu of shoving them into boxes with labels such as depression or bipolar disorder. Rather than accept that a brilliant person may have a mental condition, they are portrayed as being brilliant _despite it_. But the reverse doesn't seem to be true. Violent people, some of whom have been in and out of the prison system, get labelled with a mental illness, and suddenly everyone thinks that is the reason for them being violent. They could be violent, _despite_ the condition. It's all part of the stigmatisation of mental health issues.

He has read about writers and artists who have said they loathe being diagnosed and wouldn't give up the manic phases of their bipolar disorders or their psychotic disorders because they fear they'd lose their brand of creativity without them. They're not ignorant of the suffering it brings them, but it's still a thing they have accepted as a part of them. Others try to fix them when they don't want to be fixed according to parameters set by others. _Isn't it their right to define those, as long as it doesn't hurt them or anyone else?_

Sherlock does recognise this thought for what it is: idealism, a chasing of windmills. His childhood and teenage had been dedicated to mitigating and hiding a part of him that had made his parent drag him to see psychiatrists and therapists. Too many people medicalised his form of neuroatypicality. 'It's not normal' is translated all too often by others as mental illness. For him, it is normal to be exhausted by his battle to fit in, to mask his natural self, reshaping it to fit others' expectations. Is it any wonder that other mental health issues such as anxiety or depression occur all too often in people with autism, given how much pressure is heaped on them by having to conform to someone else's definitions of normality? If someone were to ask him if he does certain things as though his autism is a mental illness entirely separate from his personality, wouldn't he get angry, too? Frustration takes many different forms; anger is just one of them.

As Wilkes drives them the rest of the way back to Cambridge, Sherlock acknowledges to himself that his own frustrations with how this unit is going are making him angry _and_ depressed. He seems incapable of getting anything right. If he feels this way, then the patients in the thick of things must feel much worse.

That's why he's not really angry at Stephen Jones. If nobody has expected more from him, and he's convinced this is the best situation he could achieve, could anyone blame him for not putting in much effort to get better?

  
  


**Notes for the Chapter:**

> A person with schizophrenia is 14 times more likely to become the victim of a violent crime than they are to be arrested as the perpetrator of one. It's as Sherlock and Sebastian's supervisors explained in chapter 6 — even when violence happens, it is most often reactive.
> 
> The real danger diagnosis groups when it comes to violence at A&E departments and in emergency care are people under the influence of alcohol and drugs, and people with personality disorders who process things such as guilt and empathy differently. Sociopath is a mostly outdated term — the right one would be antisocial personality disorder. The word psychopath is often mistakenly used to denominate the same thing, but there are [ some nuanced differences between the two](https://www.psychologytoday.com/intl/blog/insight-is-2020/201812/difference-between-the-psychopath-and-so-called-sociopath). Once again, we see how psychiatry is very much about semantics and agreed-upon diagnostic criteria. There are two commonly used diagnostic psychiatric classifications; some professionals and organisations prefer the DSM one, while others use the ICD one.


	8. Blind Trust

It's their fifth and final Practical Clinical Skills session of the unit. Sherlock is relieved to put past him all such compulsory torment and plans to reward himself with a trip to Sarah Key Books. He hardly cares that it's reputed to be haunted; he prefers it because of the quiet, secluded reading nook in the antiquarian section. It's where he has spent many an hour just exploring the shop's eccentric and unusual selection when he's wanted a change from studying in his spartan college room. Several larger bookshop chains are represented in Cambridge, and Sherlock hates their chittery, cold fluorescent strip lighting and open spaces. At Sarah Key, bulbs in old standing lamps cast a warm, yellow, steady glow.

Once settled in the reading nook's comfortable armchair, he plans to pore over W. A. Lishman's "Organic Psychiatry: The Psychological Consequences of Cerebral Disorders". The book is not compulsory or even recommended reading for medical students; instead, it is on lists of recommended material for the Royal College of Psychiatry's Specialty exams. Directly linking physical brain pathology with psychologically experienced symptoms, this is material Sherlock can easily understand and appreciate, and hopes it will help him with his patient case presentations.

He finds the personality changes, hallucinations and emotional disinhibition produced by brain tumours in particular a fascinating entity. _Everything that happens in the brain is the result of biochemical and electric reactions, so when certain specific signalling pathways and reactions are disturbed, it's logical that the same symptoms may be produced in different patients_. Grasping the conventionally agreed-upon syndromes of psychiatric disorders in which the connection to physical brain function is less understood or seems to be missing completely is much more a challenge for him.

He hasn't touched the compulsory reading materials regarding neuropsychiatric disorders. It would be logical that he'd breeze through all of it — after all, in those disorders there _is_ a very clear link between brain abnormalities and the symptoms they produce, but he just can't bring himself to meet the topic head-on. He knows reading such materials would drain his reserves since he'd constantly have to distance himself from the contents.

Fortunately, that's not the topic for today's Practical Skills session. They're discussing old-age psychiatry this time, focusing on psychiatric side effects of polypharmacy, and managing the behavioural symptoms of dementia. During her clinical work hours, Doctor Gidleigh is a Consultant at Addenbrookes' Old Age psychiatry services.

Unlike his coursemates, who tend to joke about old patients and cluster them together as an uninteresting bunch best turfed to geriatrists, Sherlock doesn't mind the topic. If he's interested in the development of the human neurological system, why shouldn't he be interested in its decline and degeneration? There are many different dementia syndromes with differing radiological and biochemical features, and those seem to correlate rather well to the behavioural symptoms. It's patients' personalities and whether they use their intelligence in everyday life and what kind of support and medication they have which may alter the course.

They're asked to discuss a short list of written cases in groups of three. Sherlock quickly plants himself in the chair opposite David and Anwar, knowing that Wilkes will be over the moon being left only with the option of teaming up with the two girls.

David turns out to have a grandmother in palliative care with advanced Lewy body dementia, which gives him some insight into what could ail one of their fictional patients and which of the suggested medications might be useful. His parents are white-collar workers, not in healthcare, so David has had to take a leading role in attending family meetings with physicians since he's been the one who can understand at least something about the pharmacology and physiology discussed. Anwar is being his usual astute self, and Sherlock had already revised all the old age psychiatry materials so together they manage to formulate a management plan for all of the four cases with ten minutes to spare. Gidleigh seems to be pleased with their suggestions, and there is little discussion after.

Tasha Caines takes the lead in introducing their group's cases. She seems to be in a bit of a dour mood, and Sherlock wonders if it's because Wilkes and Arabella are being rather distracted with one another. He wonders whether Caines has done most of the work on their cases; the post-presentation discussion mostly happens between her and Gidleigh.

Sherlock jots down some notes from what the Clinical Lecturer tells them about how best to prepare the rest of their portfolio cases for presentation at the approaching end of the term. Shoulders straight, ready to bounce off his seat, he expects Gidleigh to send them off to lunch early.

Instead, she tells them to push the chairs aside and find their assigned pairs.

 _What NOW_? Sherlock wonders, instantly irritated. This is the _final_ session, shouldn't they be done with ridiculous exercises? The one they had done the last time had been the most unobjectionable one since it didn't entail touching anyone. Close proximity to Sebastian Wilkes was bad enough; touching the wretch was intolerable. They had sat in pairs with their chairs back-to-back; one described a thing and the other person drew it just by verbal description. The pictures were pre-assigned, abstract ones so they couldn't be named or described with words that would have helped the artist very much. He and Wilkes had done not better and not worse than the other students. Sherlock had no idea what the exercise was supposed to teach them. _Pointless nonsense_.

"We have one group exercise left, one that always gets a good laugh and ends things on a high note," Gidleigh declares. "You can change teams and repeat it as many times as you wish, but you should start with your original pair. It's quite simple, really. Your pair will close their eyes, keep their body straight and fall backwards, and two other group members are to catch them together."

Sherlock blinks. He's not even certain he's heard right. They're supposed to… _what_?!

He watches in alarmed disbelief, brows furrowed, as Arabella, David and Anwar waste no time in trying this out. They joke about David's size, but the two other students have no trouble catching him as he tilts back, then falls without any hesitation. He's then hoisted back up by the giggling, grinning yearclassmates.

"Go on. We've got six, so that's two groups," Doctor Gidleigh prompts.

"We did this in my scout group once," Tasha says, and it's impossible to tell from her serene expression whether she had appreciated the experience or not. She goes to stand next to Wilkes, glancing at him. The two of them then shift their attention to look at Sherlock expectantly.

His mouth is dry. "No," he says. "I'll… pass."

Wilkes laughs. "Think I'll drop you, Holmes?"

Somehow, his mocking tone breaks through Sherlock's anxiety and he steps closer to the boy. "You wouldn't dare."

"I won't," Tasha says politely.

All eyes in the room are now on them — perhaps because they can feel the tension between Sherlock and Wilkes, who's trying to pin him down, to challenge him with his gaze.

Sherlock takes a step forward, turns his back to the two students. He tries to close his eyes, but a shudder instantly passes through him because he can't know whether someone is about to touch him from the back or not. They're supposed to wait, that's how this works, but he can't shake the paranoia which he can recognise for what it is but cannot control. He tries to compel himself to stop holding his breath, to just get on with it, but his chest feels tight and he's frozen in place.

Wilkes clears his throat, and Sherlock's eyes fly open, his concentration shattered. Closing them is an impossibility; he's too aware of the two persons behind him, too on edge to tolerate the thought of being manhandled by them.

 _I can't do this_.

A glance over his shoulder reveals that their instructor is at the opposite end of the room. He mutters something about the loo and wastes no time in getting to the door.

Wilkes has raised his hands, laughing. "For the record, I _wouldn't_ have dropped him," he jokes, which brings a chuckle from the rest of the students. "You don't have to _run_ , Sherlock."

Feeling all eyes in the room upon him, Sherlock's hand freezes on the door handle and he retreats into a corner chair, instead.

"We kind of need a third one in the team," Tasha points out dryly.

"You think he even knows what that word means?" Wilkes snorts. "See what I've had to put up with?" He asks, directing his words to the rest of the group. "He just _has_ to make everything so bloody complicated. Bloody drama queen," he mutters, and Gidleigh gives him a warning glance.

"Not. _Doing it,"_ Sherlock snarls. If he didn't hate Wilkes so much, he would almost be grateful for the anger that the boy has raised in him again, helping him find the words.

Thankfully, Tasha claps her hand on Wilkes' shoulder before he comes up with response. "Come on," she says. "I'm sure David can stand in for him."

Sherlock doesn't watch the rest of the game — that's what it is to the other five in the group. He closes his eyes, leaning his head back against the wall, while the rest of the group goes through the exercise, each of them experiencing what it is like to allow themselves to fall backwards to be caught. He might envy them their easy familiarity with each other if he wasn't so utterly exhausted by this whole thing. The group work has been one of the toughest things about this attachment. Working with Wilkes in a clinical environment has been bad enough, but when he'd been able to focus on the cases, the idiot has been less irritating. Here, in the small group sessions, he can't avoid being confronted with his own differences in the proverbial mirror Wilkes has for some reason decided is his job to hold up for Sherlock.

The exercise winds down five minutes before the session is due to end, and Gidleigh coaxes forth a brief, general discussion about the value of trusting one's colleagues and learning how to rely on one another. The discussion is nauseatingly full of ridiculous platitudes and absurd clichés, and he doesn't participate. All in all, Sherlock finds their attitude bizarre. He knows only too well from personal experience that the reality of working in the medical profession is competitive, with points being scored with the consultants at the other students' expense. He knows he is not above doing the same thing in a desperate attempt to bolster what he knows are his strengths in the placement supervisors' eyes. Progression relies on their positive written assessments that go on his record. As much platitudes as they might exchange about loyalty and team spirit, medical students do not seem to tolerate diversity or deviation from the norm any better than other groups of people do. Why would he trust people who don't like him or wish him to do well?

Whatever Doctor Gidleigh's assessment of his input at these group teaching sessions will be, it'll be doing his grade no favours, but there is little Sherlock can do about that now.

Finally, _finally,_ the session ends. Just as he is about to slip into the safety of the corridor, Sherlock faintly registers his name being called. It's Gidleigh.

As Wilkes shoulders past him, his eyes flick from Sherlock back to the lecturer but thankfully, he doesn't open his mouth.

"Wait up, Tasha," Wilkes calls out, his knowingly suspicious smile twisting into a charmer's grin as he rushes after her.

"Sherlock? A word, please?" Gidleigh calls out again.

He freezes, clutching his bag tight against his torso. _It's not really a suggestion; I can't say no, can I?_ His skin is crawling with the desire to flee, his clothes feel too tight and it's though something invisible is reaching for him to coil around him in a chokehold. If he admits to how he's feeling, it will open him up to too much scrutiny. All he wants to do is run.

"Are you feeling alright?" She asks.

He swallows. "Al…right." The word comes out as a quiet, stretched, whiny thing instead of a properly pronounced one.

He doesn't step back into the room, so their instructor has to approach him, instead. Her smile is disgustingly concerned, and she's regarding Sherlock carefully as though unsure how to proceed. Her expression makes Sherlock worry what he may be broadcasting on his own.

She asks another question, and it's even worse than the first: "Would you like to talk about what happened?"

He shakes his head. He's finding it hard to process her questions quickly enough, let alone finding words for a reply.

"Is there something going on between you and your assigned pair? Are you not getting along? You should have approached me or one of the other teachers about that. Much of the course is already done," she reminds him, "but it's not too late if we need to rearrange pairs for your remaining clinic days."

 _'Should have'_ , he wants to repeat angrily. _'You did it wrong, Sherlock,'_ he wants to mock, hearing the faint echo of his mother in his head saying those precise words. He wants to scream, but he's lost his voice.

He can't admit to anything. _They're already onto me_. He can't tell them he can't deal with Sebastian because they'd just take it as evidence that he can't deal with other humans, period. Admitting that there's a problem would likely just lead to a teacher-moderated conversation about it, and he'd rather die than face Sebastian in such a context. Wilkes would think him utterly pathetic for running to a teacher and complaining even if the truth about their not getting along was wrenched out of him against his will. _Other people like Sebastian's company, and I don't even understand why._

Through these abominable group sessions, Gidleigh has kept providing Wilkes with opportunities to embarrass him, and Sherlock suddenly loathes her for it. "Everything's fine," he lies, probably not very successfully. He's clasping his right wrist so hard with his left hand that there's pain as he feels the soft tissues compress against bone.

Doctor Gidleigh doesn't look very satisfied with his answer, but Sherlock doesn't stick around to find out whether she'll try to probe further into the matter.

  
_____________

  
  
The walk back to his room in King's College Keynes dorm passes in a haze of anxiety. His heart won't stop pounding but knowing that his autonomic nervous system is in overdrive doesn't help him calm down. He's been on high alert ever since this damned term began, and there's still so much of it left he can't even bear to think about what torment remains in the name of education.

Back in his room, he kicks his book bag under the table and locks the door, flinching at the sound of laughter and footsteps at the end of the hall.

He'd forgot all about his plan to go read at Sarah Key's. He shouldn't get this riled up over what is clearly no challenge at all to other students, but what if he gets distracted and distraught like this during patient work? _The NHS has team-building seminars and other such nonsense, doesn't it?_

He kicks off his shoes, slumps down to sit on the bed before stretching out on it. Suddenly, he misses Victor so much that it feels like a hungry animal burrowing itself through his innards. He remembers reading about a medieval torture method in which either by heating the environment or starvation, rats were encouraged to eat the victim. Mycroft had been horrified when he'd shared this fact and told him to acquire more wholesome interests.

He curls into a ball on his bed, hugging himself so that he can grasp the fabric covering the shoulders of his jacket, coils his fingers so tight his nails dig into the soft flesh of his palms. At least this pain is of his own making. All the others — the teachers, the students — are ripping off his proverbial flesh with their demands and expectations, and he fumbles around in the dark, always coming up with the right answers but to the wrong questions.

Instead of making demands of him, Victor had shielded Sherlock from such things. he had been a _friend._ The path their life in London had taken was not sustainable, but it tears at Sherlock's heart not to know whether, under different circumstances, through better choices, they could have forged an existence together that would have made this, Cambridge, _everything_ easier. He doesn't know where Victor is, hasn't known in years. He doesn't have a phone number except the one he remembers Victor using for business. Sherlock never forgets phone numbers as much as he would prefer to delete useless ones, and during his first year at Cambridge, he had tried calling Victor once. The number had been disconnected.

His mother would be livid if she knew he's wanting nothing more than to be reunited with Victor right now. She both does and doesn't understand what it's like for him among his peers — she is well aware of how he struggles with social interactions. Her patent solution is always to quit and retreat or avoid entirely, to hide behind a diagnosis and welcome pity with open arms while trying to assimilate even if the strain of it destroys him. As much as Sherlock likes to think trying to become a doctor is just for him, that he wants to prove to himself most of all that he can do this, that's not the entire truth. For once, if he can manage to do this one his own, he will have sidestepped Violet Holmes' expectations and assumptions — redefined himself beyond her rigid, belittling ideas.

 _"Why'd you want to do that? It's so much bloody work. You can make a decent living much easier_ ," Victor had told Sherlock when he'd become the first person to whom he'd said out loud that he wanted to try for medical school. He'd tried to shrug off Victor's incredulous dismissal, but in hindsight it was one of the reasons why, in the end, he'd walked away and contacted his brother to get into rehab.

An easier life is also what Sherlock's mother always insists she wants for her son. Well, her younger son anyway. She's always encouraging Mycroft to do his best, to be exceptional, to challenge himself, to forge a great career.

 _I'm nothing_ , Sherlock thinks. _I'm just nothing at all in their eyes, if they can't see past what I can't do and accept there are things I might be good at._

________________

Hours later, judging by the waning light, he is awakened by the sound of someone knocking on his door — quite a thump, followed by a muffled voice he can't recognise, saying: "Holmes! There's a call for you."

The coin-fed wall phone is at the end of the corridor, which gives him enough time to wake up. He envies those students with Blackberries and other mobile devices, the sound of which can be turned off. Given this dorm phone is the only way clinical and teaching staff can reach him if there is a change in the placement schedule, he has to answer it.

Picking up the receiver that has been left dangling at the end of its cord, he hopes that the call is actually important. If it's his brother or a teacher calling, perhaps the lengthy delay in him getting to the phone would have led them to ring off.

Violet Holmes, however, would never be that easily dissuaded. "There you are!" she declares before Sherlock even gets a 'hello' in.

He squints at the wall clock; it's ten minutes to six.

"I was hoping to catch you before supper," his mother says. She must assume he complies with her prompts to eat in the common room with other students; dinner is served there between six and eight.

"I should have still been in the library," Sherlock protests. "What do you want?" he snaps and then wants to bite his tongue; his sharp tone and impolite words will, without a doubt, lead to a lecture.

"That's no way to speak to me, William! How are you? We haven't heard from you in ages!"

He usually puts in a call once a month to appease her; otherwise she'll be calling him and at least this way he gets a choose a day during which his patience hasn't already been drained by the rest of humanity. _Today is the worst possible time she could have called._ "There's nothing to report."

"What courses are you doing? How are they going? Oh, you'll be glad to be rid of that gynaecology course, won't you; it was _such_ a struggle."

"How nice of you to remind me." He leans down to pick up a dropped coin from the floor, the phone cord stretching and starting to strain the connection. He stands back up too quickly and has to fight dizziness as he pockets the coin. He blinks, confused why he'd suddenly feel faint and realises he's not eaten anything since breakfast. He just forgets when he's anxious.

Time to resort to a scripted question. "How's Dad?"

"Oh, he's fine, just fine, just popped out to see the neighbours to see if they couldn't spare an egg; I'm just one short."

"What's the recipe?" Distraction is one tactic he's learned works to keep his mother off track.

"Rhubarb sponge pudding. One of your favourites." 

It isn't, actually, but he isn't going to tell her that. The rhubarb he likes best comes earlier in spring. By now, the fleshy stems will be tougher and more acidic.

"And Mycroft?" Recounting the recent triumphs of the favourite son is never a brief undertaking. _Just let her talk and tune it out, she'll tire eventually._

"Haven't you spoken with him? Doesn't he call you ever so often? Oh, William, you must make an effort with your family. It's a two-way street, you know, relationships." She then launches into a report of his recent work developments.

Sherlock racks his brain to try to remember when he'd last spoken to Mycroft. His brain feels slow still from the nap he hadn't meant to take; he must've been more exhausted than he'd realised. Two students come up the stairs, walking down the corridor talking loudly. Suddenly, the idea of being overheard begins to bother him, makes him feel claustrophobic. "I need to get back to work," he snaps, interrupting her mid-sentence. "Is there a particular reason why you are ringing?"

"You sound tense. Is there something going on?"

"And what could that possibly be, other than what I am supposed to be doing, which is studying instead of talking to you?"

"Is school stressing you out? You can always come home for the weekend, have a rest."

 _God, no_. "Nothing is stressing me out. Enough with the third degree."

"A mother _knows,_ Sherlock. Have you eaten? You sound irritable. Do you have coursework due? You know there are tutors available, if you are struggling with new material."

 _And those tutors would mean disclosing things I don't want to disclose._ "I don't need a tutor; I just need people to stop pestering me."

He hears the front door close at the other end of the line; his father must have come home, which is confirmed by Violet greeting her hastily. "I have William on the phone, dear."

"Say hello for me," George replies in the background.

"Your father sends you his love. Are you sure everything is alright?"

His father had said _hello_ , nothing about love. Sherlock wonders how his mother can lie quite so blatantly. Then again, people lie all the time. At least half of all social niceties seem to be created to construct a false facade of some sort.

If he can't distract her, hell, best to deflect. "I'm fine. You ask me that every time."

"That's because I know you, dear. Have you got everything you need? We put some money on your account; don't forget to eat."

"No, mother."

"And sleep."

"I just had a nap, is that good enough for you?!"

There's a silence at the other end. "What on earth has got into you?" Violet asks, and her voice is now quieter, more alarmed than her default level of chronically concerned. "Are there exams this week?"

"No." _I should have said yes._ _That might have got her off my back_.

"William. You know you can always talk to me, don't you? That's what I'm here for."

_No, you're there to be a constant nag and make sure I know I can never do anything right._

What would he say, if he truly _could_ confide in her? It's always difficult for him to translate his emotions into words, and the process is wrought with the anxiety instilled by all those therapists she unleashed on him who wouldn't let him out of the room until he chose the right card from a pile with different feelings written on them. Endless hours of rote learning of responses and scripts and polite phrases. He often had to guess at what they wanted, and they often told him he hadn't picked the right one. He couldn't connect those words to how he felt, and they told him he always chose wrong, wrong, _wrong_. How did they know what the right one was?

"I don't like this course," he suddenly admits against his better judgement. He can count with one finger the times when he's been upset and felt as though he needed human connection; usually he wants the opposite but right now, he just wants someone to… what? To tell him it's all right? To tell him doesn't really have to do any of this? To tell him Wilkes is an idiot? To tell him he's not alone?

"And what course is that, dear?"

"Psychiatry."

"Oh. What does that entail?"

"We have group teaching and observe clinical work at different units. Mood disorders, psychotic disorders, child and adolescent psychiatry, forensic psychiatry and so on."

"Forensic? You're not exposed to criminals, are you? Is it dangerous?"

"No. I didn't get a Forensic rotation. Some other students did." He decides not to tell her about the altercation at the Poplar Acute Ward; the scratch and bruise have healed, and he doesn't want to think about it.

"Must be stressful, meeting people who are very unwell. Do you have good instructors?"

"I suppose." How could he begin to explain how even they are picking him out from the crowd —not out of malice, but because the other students have singled him out? He won't tell her about Wilkes; there's nothing she could do to help.

For a moment, he imagines her marching to the dean's office, demanding that they treat her son better. He doesn't doubt that Violet bloody Holmes would do such a thing. She can be a dragon when it comes to him, but it always, _always_ makes things worse.

There is no escape. There is no outside force that could just swoop in and fix things. He's on his own, and he certainly doesn't need the added burden of his mother getting intensely concerned about his well-being. "We have an exam next week. I've not prepared as much as I would have liked yet, which is why I should get back to studying."

"Yes, of course, dear. Don't be a stranger."

On his way back to his room, all Sherlock can think is that he has _always_ been a stranger to his mother; his behaviour inexplicable, annoying and worthy only of being changed into something more socially acceptable. She would have been happier with someone else as a son, and he knows it. _If Sebastian was hers, she would have spoiled that bastard rotten._


	9. Adventures in Primary Care

"Bloody hell…not _you!_ " Wilkes stubs out the cigarette he's smoking beside the entrance to the Cherry Hinton Surgery on Fisher's Lane.

"The feeling's mutual." Sherlock glares back at the student.

He's been smoking more than usual this term, but hardly wants Wilkes to know that. This morning he'd only lit one but would have raised his nicotine intake if he knew that today would not offer a respite from having to deal with this idiot. The best part of the Family Medicine unit this term is the fact that every one of the GP placements he's done has been with students in the cohort who are _not_ Sebastian. Having to cope with him on the Psychiatry and Mental Health unit is bad enough.

It's 7.45 in the morning, and when the nurse who also doubles as a receptionist opens the locked doors, the two medical students have only fifteen minutes to familiarise themselves with their supervisor, the clinic's practices and available services before the first patients start arriving. Wilkes seems to be in a slightly sour mood, and there are bags under his eyes. _Date gone bad?_ Sherlock wonders.

By lunchtime, his initial worries about being saddled with Wilkes have eased. When he gets to jump in with both feet into medical problem-solving, Sherlock feels more in his element than he's experienced in weeks even though many of the complaints are quite simple. He has to hand it to the Department of Family Medicine — the patients who get booked to students' GP placement sessions present a much more interesting array of ailments than what one would find in a real GP's appointment book. The aim here is education, not crisis management of the service needs of the Great British public. He and Wilkes alternate in taking the lead on appointments, with their supervising senior colleague hovering by and making sure nothing is missed and an appropriate management plan made, complete with prescriptions or referrals to a specialist or for imaging or lab work.

Wilkes manages to finagle two out of their second day's three small procedures, leaving Sherlock with only the removal of a small mole on a shin. The patient is a man in his late twenties, a rugby hobbyist and a construction worker, and Sherlock appreciates the sight of his well-defined musculature.

_Victor played rugby at Harrow._ His physique had been so different from Sherlock's — compactly, enticingly muscular and slightly shorter, a sun-kissed blond in contrast to Sherlock's pale, dark brunet and lithe, sinewy form.

"––remove the stitches, doctor?"

Sherlock is yanked out of his reverie. "No, I can't remove the stitches; I've only just put them in!"

"I was asking if they need to be removed. I meant later," the patient explains.

"No. I've used subcutaneous, dissolving stitches, they'll disappear on their own."

Wilkes is watching them from the desk chair, coffee mug in hand and an unkind amusement flickering in his slight smile.  
  


____________  
  
  


One of Wilkes' minor procedure appointments comes next. It's also the removal of a skin change, likely a small basal cell carcinoma, and things start out well enough from a boat-shaped incision. It's the suturing in which Wilkes clearly lacks both practice and talent. He's using crude, interrupted stitches which may well leave a faint herringbone pattern in the scar. Granted, the patient won't see it since it's on his back, but the buried, continuous technique Sherlock had used will be much less unsightly. Even their supervisor had complimented his work. Sherlock knows that the core curriculum states GPs and recent graduates don't need to be familiar with the technique, but why settle for less?

"You've left that one quite tight," he can't resist remarking to Wilkes, pointing to a stitch at the edge where the edges of the skin were crushed against one another like tectonic plates crashing and rising into a ridge in the middle. "You should redo it."

"It's _fine_ ," Wilkes snarls quietly. "Not everyone needs to do their stuff to death like you."

"What's this about death?" The patient asks; she is hard of hearing and over eighty years old.

"Nothing, Mrs Leland, just banter."

"You don't joke about death at my age, Doctor."

"I know, and I apologise," Wilkes tells her with a tone dripping with saccharine. "My colleague here sometimes doesn't know what's appropriate."

_And my colleague here shouldn't even be allowed to stitch in a missing button_ , Sherlock thinks.  
  


______________

"At first I thought it was just me acne actin' up––"

"It's discoid lupus. We'll prescribe oral prednisone and give you a referral to the Cambridge Dermatology unit," Sherlock declares. _Tedious_.

______________

"I think I noticed it before Harold did, took the daughter and me three months to get him to make an appointment––"

"It's very likely Parkinson's disease. Quite obvious from your walk from the door to that chair, Mister Bennett, not to mention the tremor in your left hand, and the manner in which your muscles worked like a cogwheel turning when I shook your striatally deformed hand."

_"Parkinson's!?_ That's serious, isn't it?"

"It can be, but it affects different people differently. The fact that you drop your left foot and you have a tremor could be a sign of other neurological problems, so we'll have to go through some imaging and blood work to rule certain things out. I will get the surgery to provide a referral to the neurology unit at Addenbrookes. They will do a series of tests to confirm the diagnosis and come up with a treatment plan that works for you, Mister Bennet. Plenty of medications available, many of them effective. Your symptom cluster seems quite classic, especially with very distinct bradykinesia and the striatal hand changes."

"Brady––?"

"The referral will be sent directly to the hospital so off you pop. They'll explain everything to you at the neurology clinic."  
  


______________

"Took me a week to get an appoint––"

"Shingles. We'll prescribe an antiepileptic to prevent chronic pain, and an antiviral to shorten the course of this visible phase. You don't have any immunocompromising medications or illnesses, do you?"

"What's an immuno…whatever you just said?"

"Never mind, I will check that from your records on file here; how long have you been a patient at this surgery?"

"Thirty years, come next month."

Sherlock consults the record on the screen. "Good, that means your records here should be comprehensive. You were seventy last year, so you were eligible for a shingles vaccine, but there is no record of you taking it here."

"Me granny had shingles; she told me it's an old ladies'––" The patient begins to dismiss.

"Seventy qualifies as old, Mrs Thompson, which is why you were offered the vaccination."

"I don't know about those; my daughter says they cause more harm than good. She says homeopathy's better."

"Next time they offer you something that's actually based on scientific evidence such as vaccinations, I suggest you take it. The shingles vaccine might have saved you from this infection, or at least made the symptoms milder."

"Oh… no need to be rude."

"Once my supervisor approves my prescription, you can pick it up from reception and get it filled at your chemist." _Now go away_.  
  


______________

After the last patient of the morning half of the day leaves, Dr Burrock, the supervising GP debriefs the students on their work.

"Diagnostics-wise, you are doing an exemplary job, Sherlock," the grey-haired GP tells them, "but it would do you well to have a bit more patience with the patients."

"With the time constraints the NHS puts on GPs, it's more efficient to avoid faffing about."

"That may be true," Dr Burrock admits, "but unless you take the time to explain your management plan in a way that patients understand, they're unlikely to adhere to it."

Sherlock doesn't respond. He's never understood why patients aren't expected to do their part, to educate themselves about their ailments. Why is it a physician's job to patch up their lacklustre knowledge base? _Why are people so idiotic?_

"It's the people — the patients and their family members — who make this such a great specialism. Talking to them, getting to know them," Dr Burrock muses.

_The last thing I want to do is to get to know any of them_ , Sherlock thinks.

Suddenly, he realises that — judging by the looks the other two in the room are giving him — he had said all that out loud.

Wilkes is feigning disgust, and even Dr Burrock looks a bit… put off. "Ah, yes. You're the one who wants to be a neurosurgeon, is that right?"

When Sherlock nods, the GP gives a rueful smile. "Well, you'll still have to talk to patients and earn their trust before they are going to let you poke around in their brains."  
  


______________

The surgery is closed for one hour over lunch. Sherlock marches resolutely out and into the nearest Tesco Express, then takes his sandwich and juice carton to a park bench by the Cherry Hinton Cenotaph at the edge of the recreation ground close the surgery. He tries not to let the unfortunate exchange about his future plans get to him and hopes that the afternoon will provide opportunities to further impress Dr Burrock with things at which he _is_ skilled.

As if often the case, his store-bought sandwiches consist of soggy bread and too much mayonnaise, and he only eats half of one. The breakfast he'd managed to get down for once should sustain him until the afternoon. It's such a bore, having to consider food and sorting out other domestic things. It had been the only acceptable thing about still living at home: no need to worry about laundry or sustenance or cleaning. His mother did it all, and never really demanded that he participate. Presumably, that was because she assumed that he couldn't manage. Mycroft always had assigned chores which he attended to without protest and with the same kind of pompous meticulousness which characterised all his actions. Their parents liked to praise him for being such a responsible and precocious child, and Sherlock had to hand it to him — it was a good tactic for flying under Violet's radar. It was one he might have employed if there was a chance of success. Even if he did suddenly turn into some domestic wonder, Violet Holmes would just ignore it and find other things to criticise. Food, clothes and personal hygiene are frequent topics for lectures she still delivers during their phone calls.

When he had shared a flat with Victor, Sherlock can't remember having a single conversation about such issues. Admittedly they hadn't been very high on their radar. As Victor's use escalated, the state of their flat deteriorated, but Sherlock had been using as well, which made him care less. Normally, he is particular about his clothes and cleanliness. It's just that he gets very distracted sometimes.

_____________

  
The afternoon starts badly — at least for Wilkes, who looks unsure as he auscultates the lungs of a twenty-two-year-old woman of Chinese descent. She and her mother had immigrated to the UK only a few years prior and are both working in a local cleaning firm. She is presenting with a cough and mild fever with yellow sputum, but vital signs are otherwise normal and Sherlock, sitting at the back of the room observing, notes that she is oriented to time and place and has no neck stiffness. _Likely not a central nervous system infection, then_.

What worries the three physicians are the long, ecchymotic welts on her back. Small blood vessels have broken in and underneath the skin, bleeding into the tissues. The marks are oddly symmetrical, but then again, many types of rashes are. _Could be caused by an infection, some other type of an immunological reaction, or a reaction to a drug or some other substance. Or…_ He stands up and approaches the women to see better.

"Miss Zhou––" Wilkes starts, exchanging glances with Dr Burrock, "I believe you need to be seen at the University Hospital's Emergency Department. You may be suffering from a serious infection."

The young woman looks apprehensive. "What does it mean, this word, serious?"

"The marks on your back could mean sepsis," Wilkes says emphatically. "It was very good that you came to see us today."

"It's not sepsis," Sherlock scoffs, having retreated back into his chair. "Don't you have _eyes_?"

"Sherlock," Doctor Burrock warns quietly. "Politely, please."

Sherlock ignores the GP. He's caught the end of the diagnostic trail and followed it to its only possible conclusion. _God, are their brains really so slow and unimaginative!_ "Those are not infectious petechiae — it's _gua sha_!"

"You'll have to explain further," Doctor Burrock says.

At the same time, the young woman nods, eyes cast down. "Gua sha," she confirms quietly. "Not… illegal?"

"No, it's hardly illegal — unless done on a child, in which case it might count as abuse," Sherlock responds before Wilkes gets his act back together. "What it _is_ , however, is bloody stupid and useless."

Wilkes is now glaring daggers at him. "She's feverish and has bleeding under the skin. How is that not a sign of a severe bacterial infection?"

"Look at the pattern," Sherlock says. " _Gua sha_ , also known as _coining_ , entails scraping an object along the skin to break the blood vessels. It is supposed to remove what is described as 'internal heating', whatever nonsense that even means. It's used in Chinese and Vietnamese medicine for various ailments."

"I believe I have heard of coining, but can we be certain of it without lab work and ruling out what Sebastian has suspected?" Doctor Burrock asks.

Sherlock sighs. The question had been probably rhetorical. "She's just confirmed what I said, but by all means, send her to A&E, then. I'm sure they love their time being wasted."

  
_____________

"We shall do an ENMG, and once the results are in, we can ask a surgeon if they could do something about the nerve entrapment. Physical therapy could also––" Wilkes is explaining his proposed treatment plan to the patient, a forty-five-year-old schoolteacher who is an avid knitter.

"Or, you could take her calcium levels, write her up with a supplement after ruling out primary hyperparathyroidism, and be done," Sherlock pipes up.

Wilkes' head whips around to attempt ocular homicide of Sherlock once again. "What?"

"Trousseau's sign."

"True _what_?"

"I believe Sherlock suspects latent tetany, don't you, Sherlock?" Doctor Burrock suggests.

"When you took her blood pressure and wrestled with the stethoscope as though it was the Kraken, the patient's brachial artery was devoid of pulsation for long enough to demonstrate hypocalcemia and subsequent neuromuscular irritability in the form of her hand forming a swan's head shape or, as they originally named it, her hand showed the _man d'accoucheur_ — the _hand of the obstetrician_ — with the fingers tight together, and the wrist flexed. May I?" Sherlock has risen back to his feet.

How could he not intervene when Wilkes is missing everything obvious and making the wrong diagnosis?

The patient, baffled, nods, and Dr Burrock looks encouragingly expectant.

Sherlock taps her face gently in front of her ear, which makes her nose and her upper lip twitch. "Chvostek sign. Hyperexcitability of the facial nerve. Order labs, and you'll find she's hypocalcemic."

"Well done!" Dr Burrock says. "Often, if we listen and do a thorough status exam, that gives us the diagnosis instead of costly imaging or neuromuscular studies."

"It would have shown up on the ENMG, wouldn't it?" Wilkes tries.

"That would be a waste of resources. Now, she will be spared of the painful parts of that exam," Sherlock replies, arms crossed. "No need to hook up the patient's skin to electrodes and make her endure electrical impulses to test nerve function just because you can't see the obvious. I suppose you'd like to cut open a patient's neck open to see whether their thyroid is enlarged?" Sherlock scoffs at Wilkes. _Serves him right for all the insinuations that I'd attempt to solve any medical problem with surgery._

The patient looks alarmed at the exchange, but Sherlock doesn't notice. He and Wilkes are glaring at each other so directly that it is only with delay and just in his peripheral vision that Sherlock sees the patient get even paler at his last statement.

Doctor Burrock intervenes. "He didn't mean you, Miss Chen. It was just a figure of speech."

Sherlock is relieved that his diagnosis prevails according to Dr Burrock, who takes over making the arrangements. Even though they had exchanged a few personal barbs, surely Wilkes shouldn't be looking at him so venomously; all he did was jump in to provide the right diagnosis. Surely it's the most important thing for the patient, never mind someone's ego getting a bit dented? _Especially when it's deserved._

_____________

Wilkes fumes for the remainder of their day, which is spent listening to a presentation by one of the GP surgery's partners about legislation pertaining to patient safety, particularly when it comes to safeguarding the elderly and children.

It is only as they are leaving that Wilkes talks to Sherlock again. They're alone in the staff room; Sherlock is looping his scarf around his neck when the slightly shorter but burlier Sebastian steps into his personal space.

"Think you're so fucking smart, and so much better than anybody else, do you?"

Sherlock doubts that he wants to hear the honest answer. Yes, he's certainly a better diagnostician than Sebastian Wilkes.

Sherlock sidesteps to leave but gets intercepted by Wilkes who plants himself firmly in his path.

"You think they'll tolerate you for a minute in any real placement after we graduate, hm? You think any surgical unit won't kick you out on your arse when you've insulted all the staff and put the wind up every patient in the first five minutes? You think any colleague who you've pissed off will be willing to help you when you get snowed in at A&E at two in the morning?"

"No, I don't expect anyone to pitch in, because they will be slower than me in reaching the right diagnosis."

"You'll get yours, Holmes. You'll run out of the road, and the car crash that's coming in your medical career will _make_ _my fucking day_."

With that, Wilkes pivots on his heel and strides out the back door of the surgery, deliberately knocking Sherlock aside with his shoulder.  
  


_____________

Is it a coincidence that puts the two of them back together in another GP surgery only the next day? Sherlock is not one for superstitious thinking, but it does seem particularly unfortunate that their next placement for the psychiatry course is at the Bridge Street Medical Centre. Not only is this going to be challenging because it involves him and Wilkes dealing with mental health patients in a primary care setting; it is making him double uncomfortable because this is the same surgery where he is registered as a patient.

His one and only visit here happened in his first week of being up at Cambridge when he'd stopped by to fill in his registration form. His mother had insisted he do so, and the college seemed to require it, so he'd gone through the motions. If he chose to be somewhat economical with the truth about his previous medical history on the form, this is something that he hopes no one will call him out on now that he is four years into his medical training. He needs desperately to play the role of being normal to the GP supervising their work today. Being irritated by Wilkes adds more strain yet, and he finds that sitting still is getting increasingly difficult. He's already forgot the name and profession of the Trust's staff member who is explaining the unit's psychiatric care processes to the two of them.

"PRISM — meaning the Primary Care Mental Health Service — is all about extending such services into the community. When a GP makes a referral, we are the first port of call. Unless the patient is in crisis, we will see them and do an assessment and work with the patient on a treatment plan and decide what support they are going to need to deliver the agreed goals."

The woman removes the cardigan she'd draped on her shoulders, and Sherlock can now read her nametag. Stephanie Southall is a Mental Health Nurse Practitioner in her early thirties, but Sherlock decides she must look younger. _At least_ _if Wilkes'_ _dim attempts_ _to flirt with her is anything to go by_. As per Sherlock's observations, Sebastian tends to revert to this overtly sexualised approach to young women whenever he can when meeting new people. Sherlock finds this distasteful and unprofessional, even if the women colleagues seem able to fend him off without undue distress. Some of them seem to even enjoy the attention.

"We come to this surgery only twice a month, and today we have a full roster, so you will get exposure to a range of mental health concerns. I am here to help you in the initial assessment and proposed treatment plan for six patients, one of whom is returning to the community following a three-week-stay at the acute unit at Fulbourn."

Ms Southall smiles as she hands over six folders. "I suggest that you two look these over and decide which of you is going to take the lead on which patient, while I go get a coffee. We'll be meeting the first patient in thirty minutes — Mrs Nazir, who has been referred to us as a suspected case of postnatal depression."

As soon as the door is closed behind the Nurse Practitioner, Wilkes is smirking. "I'm going to make a wild guess that you're not keen on the postnatal depression one."

Sherlock gives a wan smile.

"Predictable, given your total abhorrence of anything relating to gynae & obs. Lady bits not your thing, eh?" Sebastian shuffles through the pile of files. "I'll do Nazir if you take this nutjob." He hands over a file for a Jason Willoughby.

Sherlock grimaces. "I thought we are supposed to treat patients with respect."

"Yes, we should be respectful _to their faces_." Wilkes carefully pronounces the words as though talking to a child. "Behind their backs is another thing entirely." He snorts. "Besides, that's a barmy comment coming from _you_. It's obvious you think everyone's an idiot, especially patients. I just like to call 'em as I see 'em. Waste of time, giving psych appointments to junkies."

Sherlock isn't surprised by such a statement coming from Wilkes, but it still makes his blood boil. He hates this kind of attitude from anyone; the stigma attached to people with addiction issues is as rife amongst the medical profession as it is within the general population. Hearing Wilkes re-emphasising it now adds another twist to his anxiety levels.

He opens the Jason Willoughby folder, giving it a quick skim to discover that the patient is a forty-two-year-old divorced man who developed a substance abuse problem following a long period of unemployment. He has been in and out of rehab programmes over the past six years, but not managed to stay clean long enough to find a job. He has used various opioids and drinks heavily.

Sherlock nods to Wilkes with a sigh. "I'll take this one."

_____________  
  
  


"Sherlock, what advice would you give to Sebastian about how to have handled that better?"

Ms Southall's question catches Sherlock off-guard. Mrs Nazir had been in nearly in tears and not at all happy about the referral, insisting that there is nothing wrong with her; her explanation for her symptoms is that she is just tired. Sebastian's questioning had been increasingly persistent but fruitless in getting her to accept that she is in need of any form of counselling. Eventually but still very reluctantly, she had agreed to the Nurse Practitioner's suggestion of a follow-up appointment at the end of the month.

As far as Sherlock could tell, the criteria for diagnosing postpartum depression were likely met in her case, as detailed by other healthcare professionals who had observed her and spoken with her before: mood swings and generally low mood, difficulties concentrating, visible exhaustion and with extreme insomnia. Much of it was things that most new parents experienced, but what was not in any way normal were the unrealistic, paranoid and paralysing fears Mrs Nazir had about the safety of her infant — including worries that she might harm him without realising. Her mother-in-law had been pressuring her to leave her own flat and move in, but she wasn't prepared to do it. Mrs Nazir seemed unaware of how chaotic and difficult things at home had become. Her mother-in-law had called child protective services who are now making daily visits. Mr Nazir works as a helicopter pilot for an oil rig and has been away for work for the past two weeks.

"Well, it was obvious she didn't want to talk to us," Sherlock concludes. "Trying six different ways of asking the same question is a waste of everyone's time. I think she would have been happier speaking to you alone, without the presence of two men, both strangers, in the room."

Wilkes shrugs, "She consented to all of us being here."

"Possibly because her cultural norms tell her to obey males in positions of authority who ask her to do things," Sherlock points out. "Those same norms would make it unlikely that she'd be willing to admit to being anything other than in perfect health. To do otherwise would cast suspicions on her worth as a wife. ."

The Nurse Practitioner nods. "I agree, which is why I asked her to arrange a follow-up appointment where I can speak to her in private. It seems that she is under marital stress from the husband's work absences and lacking a support network of her own outside his mother, who is heaping the pressure on her. She was too coherent to be psychotic, so an outpatient approach is still possible. When I speak with her again tomorrow, I will encourage her to join some young mother groups where she might find peer support. Mister Wilkes, a bit of respect for cultural diversity would help in patient relations."

This earns her a nod from Wilkes, which turns into a scowl at Sherlock as Southall heads for the door to escort their next patient in.

"Trying to show me up again, Holmes?" Sebastian asks. He's leaning back against the chair, looking petulant.

Southall turns to face them, hand perched on the door handle. "It's not a competition. We're all here to learn and shouldn't overlook the knowledge of our peers. I often ask for advice from other Nurse Practitioners instead of going to my supervisor or one of our Consultants. It doesn't matter what someone's name badge says — people have different knowledge bases and experience, so you never know who might be able to give you the most useful answers unless you're willing to ask for help."

It's only when the next patient enters the room that Sebastian stops looking like a disgruntled teenager and perks up.  
  


_____________  
  
  


Ten minutes later, Sherlock is having difficulties stifling his impatience. "It would help if you would answer the question directly," he prompts their next patient.

Sharon Hills is a thirty-three-year-old secretary for a local IT company. Her bipolar disorder had been diagnosed three years ago, and she is on medication to control it. She is claiming that her employers are trying to get rid of her, wanting the surgery to provide a disability statement so she can take them to an industrial tribunal for constructive dismissal.

"The domains of functional assessment for disability are quite clear, and a statement can only be issued if you can prove that you are unable to function to the level required in the five categories —so long as you keep taking your medications," Sherlock explains.

He then repeats his question. "Have you experienced any recent episodes of dizziness or ringing in your ears?"

"Yes, to both. But I don't see what that has to do with anything."

Sherlock jots down a new line in his notes — _increased irritability_? Returning to the form, he asks "So, Miss Hills, can you provide a concrete example of how your employer cannot consistently rely upon you to perform the duties you are asked to perform?"

Sherlock already knows the answer. Her labile emotions, her inability to control her impulsive behaviour is a clear indication that she is either off her meds entirely or has cut them back to the point where they are no longer keeping her stable.

"It's _them_ , not me. I mean, it's not reasonable that they expect me to work overtime every night, ringing up customers who haven't paid their bills on time. I get fed up with it all and go home because I can't cope with the stress."

"Is this part of the job description, to help out at year-end?"

Reluctantly, she nods. "It's unreasonable to ask someone in my state to do it. I can hardly muster the strength to get out of bed in the morning, and they're just making things worse. They're discriminating against me and trying to get rid of me."

Her anger and general demeanour do not resemble what Sherlock would expect during a depressive phase of bipolar disorder. _Could be a mixed episode, or approaching mania._

He consults her treatment plan in the folder. "I understand you agreed with the psychiatrist who prescribed the antidepressants that you would keep a week-long diary of symptoms whenever you felt the symptoms were not being controlled by the medication. Have you brought that with you?"

She rolls her eyes histrionically and throws herself back into the chair. "What are you? The Thought Police? Are you on their side?" She looks at the nurse and Wilkes, who is sitting at the back of the small consulting room. "Are you recording this? Is he paying you to record this?"

Sherlock makes another note — _paranoia_. This time there is no question mark to be added. "No, Miss Hills. Patient confidentiality means that the things that you say in this room cannot be disclosed to any outsider. Can you confirm the last date you put in for a prescription renewal for the lithium or the Zyprexa?"

"No, I damn well won't. I'm not playing this game." She picks up her handbag from the floor and gets up from the chair. She glares at Miss Southall. "I agreed to have this… medical student here, but I certainly didn't expect this sort of treatment."

Miss Southall steps forward. "Miss Hills, please accept my apologies. Mister Holmes is only asking questions that are required for a functional disability statement. The questions are not his, but rather those of the DHSS. We have to ask these things before we can then move forward."

"Well, I'm not going to answer!" Miss Hills storms out and slams the door behind her.

Miss Southall bites her lip. "Sherlock? What do you suspect?"

"My theory is that she's purposefully stopped taking her medications to exacerbate the symptoms in order to put the disability claim in, hoping that the employer will pay her off rather than face an industrial tribunal. I don't doubt that her work is stressful, possibly too stressful for her even when her bipolar is well-managed, but that assessment should be made when she is well-functioning, not when the situation is this unclear."

"Mister Wilkes, do you concur?"

Sebastian looks reluctant. "What if it's just mania and not some master plan? Don't bipolar patients chuck out their meds all the time when they're going through such an episode?"

Sherlock resists the temptation to roll his eyes. "Her symptoms point more towards medication withdrawal and possibly a mixed episode rather than pure mania. She is still rather functional. She will make contact again, I'm sure because without a medical statement, she cannot move forward with her complaint with the employer. Requiring a random blood test would provide conclusive evidence that she is not adhering to the treatment plan."

Miss Southall takes his side. "I will make that recommendation to the GP who referred her. Perhaps knowing the appointment could happen at any time will convince her to go back on the meds. If she is taking them properly, and she is still unable to work, then we can have a re-think. Well done, Holmes."  
  


_____________

After Miss Hills, Wilkes deals with an elderly patient who is depressed after the death of his wife. All the proper noise of consoling him for his loss and counselling him to consider now being able to do things which he'd been unable to do while caring for his dying wife seem to hit home, and the patient leaves in a visibly better mood as far as Sherlock can tell. He can only cringe internally at the idea that being an agony aunt for someone is a proper role for a medical professional. He thanks his luck that Wilkes had grabbed that patient folder; it's the sort of emotional, touchy-feely stuff that he loathes and Sebastian is rather good at.

Perhaps that exasperation is what sets him up badly for the last patient, Jason Willoughby. He's been referred by the GP because he'd made an appointment to deal with chronic pain for a bad back. Given his past history of opiate abuse, this results in an automatic referral to the PRISM practitioner to decide whether the Community Mental Health Team who are monitoring his post-rehab treatment plan need to be informed.

"I can't work; my back was done in by twenty years at the Ridgeons Timber Yard in Nuffield. Every bloody time I try to get back on my feet, the pain flares up."

Sherlock considers the file. Over the years, there have been repeated MRI scans to find a physiological cause for the pain, and nothing points to an underlying injury or problem. "It says on your file that you've missed three of your last appointments with the physical therapist here at the surgery."

"Yeah, 'course I have. If I can't get out of bed, I can hardly crawl here on my hands and knees."

"What medications are you currently taking for the pain?"

"If you doctors would listen to me, you'd put me back on the highest strength painkillers. Anything else is just torture. As it is, the occasional Nurofen Plus when I can get it from the chemist."

"You do know that it contains codeine and is limited to three day's concurrent usage only?"

"Yeah, I know." Tall and on the wrong side of the borderline between overweight and obese, the big man sighs. "All the pharmacies in the area are on my case, okay?"

"If you were willing to exercise more, to get your weight down and built your muscles and tendons slowly back to where they can maintain proper posture, then the strain and pain should ease. That's why physical therapy is prescribed. Drugs are not the answer."

As soon as he says this, Sherlock hears his own mother telling him those exact words about drugs when she and his father had visited him in rehab. Mycroft had broken the news about Sherlock's issues to them after he had been in rehab for a week. After Sherlock had called him and asked for help, Mycroft had hosted him for a few days in London as they waited for a spot to become available at the facility he'd chosen for Sherlock. He's grateful for the way Mycroft had acted surprisingly non-judgemental and focused on practicalities back then. Sherlock would never describe his relationship with his brother as close during their adulthood, but that had been, by far, the nicest thing any family member had ever done for him — just helped without lecturing and making him feel worthless. Perhaps Mycroft had realised there would be plenty enough of that from their mother.

Their patient is looking at Sherlock with frustrated suspicion. "You don't understand. It's like a bloody broken record, you lot. You? You're hardly out of your posh public school, going to university — what right have you to lecture me to do this, do that?! You haven't a clue; you're not the one living with this sort of pain day in, day out. You don't know what it's like to lose a job, lose a marriage, get kicked out — Christ, if it weren't for the dole and housing benefit, I'd be out on the street. I can't get a job because I don't know from one day to the next if I can stand the pain to turn up at the jobcentre, only to be told there's nothing. Is it any wonder that I want to just numb that for a moment? What else have I got, eh?"

For a moment — but only just a moment — Sherlock wants to tell this man that he does understand perfectly what it's like to be penniless, nearly homeless since his and Victor's landlord was constantly threatening eviction, and that he also knows what it's like to be on drugs and living without much hope for the future.

An awkward silence fills the void as he tries to find the right words. There is no social script he can rely on, no standard doctor's words that can bring about a change of heart in the man's attitude towards a treatment plan. Nothing anyone else had said to him after the debacle with Victor had made any difference, so what could he possibly have to offer to this man, and what right has he to preach about these things? _I had to find the motivation to choose differently. Nobody could do that for me_.

"What's the alternative?" Sherlock finally asks.

Willoughby looks at him warily. "What does that mean?"

"If you can't get yourself out of this pit you find yourself in and can't — or won't — commit to the treatment plan that people are trying to help you with, you are just going to repeat the cycle of rehabilitation, release and then repudiation of a treatment plan you obviously don't care enough about to try out, spiralling ever downward. So, what is the alternative?"

The patient looks down at the floor and mutters, "That's the question, right there. If the pain's not going to go away, and you won't give me something to deal with it, then it's going to be drinking, or getting my mates to buy the codeine, or worse… having to start on heroin again."

"And where do you think that will take you?"

The big man stares at him. "Back over the edge. At least that shit works until it doesn't. Yeah, when I get fed up with it all, when I can't see any way out, then the answer's right there in what I can buy off the street, and I know how much I need to take to really put an end to all of it."

Behind him, Sherlock hears Miss Southall shift uncomfortably in her seat.

"Are you seriously considering suicide? Do you think it's the way out?" Sherlock presses. "The fact that you've come here today instead of scoring on the street tells me you've not given up completely. Not yet. And that means we've got something to work with."

Willoughby scowls and crosses his arms defensively. "I'm not a quitter, but this pain? I can't live with it."

"Then _do_ something about it. Go to the physio, recognise that the pain you are feeling right now cannot be numbed out of existence. Doctors can't do it for you. Use the pain. Use it to get angry enough to do something. Even if it’s just to force yourself to walk for half an hour a day. Stop using the pain as an excuse. Go join an AA group. There are other substance abusers who are in similar, if not worse, situations than yours. Self-medication is not an answer. Doing nothing is no solution — it's also a choice because things will only get worse."

"What can you, or someone else tell me that's going to change things?"

Sherlock nods. "Nothing. No one can _tell_ you. It has to be you, making a decision. You have to want to live, to achieve something that gets you through each day. No matter how painful, how difficult, you and you alone, Mister Willoughby, have to find it because it is the only alternative that will make you stick to your treatment plan and get better."

"Well, that's telling it straight. No doctor's ever put it like that before." Mister Willoughby's gaze has softened. He's looking at Sherlock almost… approvingly?

"Doctors can be too polite. This is too important to be polite about it."

The big man nods slowly, thoughtfully. "I'll think about it."

"Thinking won't get you to the next physio appointment. You have to agree to it and show up. If you won't, then you should tell me now, and the appointment will be given to someone else in need who will actually use it to get better."

Willoughby looks surprised. "You'd do that?"

Sherlock nods, hoping that the Nurse Practitioner won't contradict him. She gives him a tiny nod of support. "Watch me."

"Then keep my name on that appointment, Doc."

Sherlock's smile is relieved. "Will do."

_____________  
  
  


When the patient has left the room, Miss Southall wraps up the day's session, giving them feedback on their work. In the end, she asks Sebastian what he thought of Sherlock's handling of Jason Willoughby.

"Sounded like he knew what he was talking about. First time I've heard anything from him that sounds remotely like he understands what the patient is feeling. Being down and out, strung out on drugs…" He stares at Sherlock as if reassessing what he knows about his classmate. "Sounded almost like empathy," he concludes.

Instead of praise, it sounds like an accusation.

Miss Southall has a rather pained expression. "That is a bit personal when it comes to feedback, Mister Wilkes. I think it would be more appropriate to say that Mister Holmes found a way to connect that helped the patient accept that the advice given might be valid, and encouraged them to think differently about their situation and to commit to trying out the treatment plan. Did you notice he didn't even ask for a prescription renewal before he left?"

Sherlock knows he should feel triumphant, but instead, anxiety is creeping in, and he struggles to keep his own expression neutral. His success with Willoughby seems to have made some ominous cogs start turning in Wilkes' head. Has he let his own emotions get the better of him?

Has he handed his enemy something that could be used against him?  
  
  



	10. Make My Day

**Notes for the Chapter:**

> Potentially triggering content in this chapter: discussion and description of ECT (electro-convulsive treatment/therapy) for psychiatric disorders, bullying.

"Hello?"

"Is this Professor Violet Holmes?"

"Yes? I'm afraid I am mentoring a student, so you'll have to––"

"I'm Doctor Wil–– _lis_ from Cambridge University's Student Counselling Service. I'm calling about your son."

"Oh. Oh! What is the matter? What's happened to William?"

"William…?"

"Oh, I keep forgetting he insists on going by Sherlock, now. Some whim of his."

There is rustling at the other end of the line; it sounds as though Professor Violet Holmes is repositioning the receiver so it can be held momentarily away from her mouth. "Laurie; I'm sorry I have to take this. Could we reconvene after lunch if you have a free period?"

More rustling. "Apologies. Now, what is it you are calling about?"

"I'm afraid Sherlock has been having some difficulties with his studies. He has given us your contact information with a suggestion that you might shed some light on his background. It's hard for him to tell us these things."

"Oh, I cannot tell you how _delighted_ and _relieved_ I am that the boy has finally seen sense and sought counselling! I could tell something was going on; he seemed so stressed the last we spoke. He's disclosed it, then, finally?"

"Yes… yes, he has. If there's anything you could tell us which could make it easier to help him, we'd be grateful."

"Where should I even start?" There's a creaking of chair legs against a hard surface. "Is he also in contact with the Disability Resource Centre? I understand they're the ones who help with negotiating adjustments. He's spent years banging his head against the wall; whatever is the use of making things even more difficult for himself?"

"Indeed. Now, what can you––"

"Is it the psychiatry course? That's what he told me he was taking this term. I knew, I just _knew_ it might be the test to destruction. There's so much exposure to patients in this stage of medical school; how could he _not_ be struggling?"

"I take it communication difficulties are a life-long issue for him, then?"

"Yes, and I wish it was his only issue. He has no empathy, you see, can't imagine what goes on in other people's heads. That's what the specialists told me. People don't interest him, so I never understood why he'd want to try medicine. He cannot recognise feelings in others, let alone himself. Oh, the tantrums he had when he was small when he couldn't contain or understand his frustrations."

"Has he… been on any medications?"

"Oh, there were several that were tried, but he often had paradoxical reactions to them, and the side effects were mostly intolerable. He was very skilled at hiding things, pretending he'd taken them."

"Has he ever received inpatient care?"

"Once, after that dreadful thing happened with that other boy from Harrow, Victor. They ran away to London, and he was the one who got William onto drugs. Oh, tell me he's not using? Please tell me it's not the reason he's contacted you."

"It's not, no, but this is all very useful, Professor Holmes. What other things Sherlock struggles with, then?"

"He has always had obscure and restrictive interests which he imposes on other people on the rare occasion when he chooses to communicate with them. There are also repetitive behaviours he eventually realised he must control in public. Oh, it was such a battle with the therapists until he learned and, under duress, they still break out and embarrass him. Terrible executive dysfunction; there were systems with alarms and notes we had to develop for him to get through the mornings and his school days. It's hard to direct his attention and he obsesses over things; perhaps this fixation with medical school is one of them. Most likely it's just some childish rebellion just like that year he spent in London with that other boy."

"You don't think medicine is a good fit for him?"

"God, no. We told him that, my husband and I, and his brother agrees. But would William listen? He should have focused on natural sciences, not something requiring him to deal with other people. He's very intelligent, you know."

"He's managed this far."

"Yes, but what will happen when the infrastructure of Cambridge is gone, and he has to fend for himself as a junior doctor? Now, his behaviour and lacking skills can be chalked up to him being just a student. What will happen when he has to take full responsibility for his conduct? I just fear this doctor thing has become some mission for him to prove a point he doesn't need to prove. I sincerely wish that, with your help, he will examine his motivations and disengage from such stubborn, childish ideas. Have you spoken to him, personally? What did he tell you?"

"I'm afraid that must remain confidential, but we have had repeated contact. We don't have access to his GP records, so I would be grateful if you could confirm his long-standing diagnoses for us."

"Why am I not surprised he's refused to discuss those with you? Honestly, how does he expect people to help him when he doesn't give them the tools to do so? But yes, yes, of course. He had repeated middle-ear infections as a child, but I believe those left no permanent issues, so I guess there's just his autism, then."

"Right, yes. What sort of treatment has he received for it?"

"There is no _treatment_ , of course, not one that would fix it. They say it's a malfunction of neural development, the brain working differently. Some connections are lacking, and some are in overdrive. He's had various kinds of therapies — the best we could find. Motivation issues notwithstanding, he is able to assimilate himself as high-functioning when he so chooses. He's just so stubborn, our William. Did you notice the stimming? He's always had a problem with keeping that in check, especially when stressed."

"Yes, it definitely seems to afflict him. No other major health issues, then?"

"Not that I can think of, no. If you speak with him, please remind him how important it is to keep in touch. As I said, I could _tell_ something was up. A mother just _knows_."

"Did he always want to be a doctor?"

"No, not at all. As I said, it seemed to be a whim. I cannot for the life of me work out where he got the idea; he says it happened when was living in London with that Victor, but since they seemed to be mostly loitering around doing drugs, I doubt that period of his life could have inspired anything. But when he came home from rehab, medical textbooks were all he read. We were glad he was interested in something; as I said, he's always had periodic intense fascinations which came and went, always followed by the next one — typical for those with his diagnosis, of course — and we waited for this one to pass. In a way, I think we still are. If he's struggling, then perhaps the time is near when he would be willing to listen to counsel about what things he would be better suited for."

"How did he do at school?"

"He is very gifted academically, of course, it's the other children that were the problem. I had to pull him out of that dreadful school in the village we lived in; the teachers there had no idea what to do with him. We moved here when he was two years old because we hoped it would be a less stressful environment for him than London, but the staff at the school had no training for children like him. Mind you, very few people did. It was all relatively new, still."

"What was?"

"Autism, of course."

"So, you pulled him out of school."

"Yes, and I homeschooled him until he was old enough to follow in his brother's path to Harrow. I would have chosen a non-boarding option closer to us, but my husband insisted he'd be fine."

"Was he? Fine?"

There is a sigh from Professor Holmes. "His A-level results were exemplary, yet he elected to run away from home. You tell me."

"He must have been about… eighteen at the time? I'm not sure that constitutes as running away if he was of age––"

"If he were a _normal_ young man, you'd be very correct. William cannot possibly manage on his own."

"Is he… he's not classed as a vulnerable adult, is he?"

"No, though I must say there are some compelling arguments on both sides of that particular fence. Now tell me, Doctor — you must be able to say something since he's authorised you to speak with me — how is my William doing, really?"

"This medical school term has proven very challenging for him. It doesn't help that he is not very well-liked by his peers. Has a tendency to one-up them in class."

"Oh, I am not surprised at all. It's a defence mechanism. If you can't talk about why he came to you, can you tell me what you are doing to support him?"

"We are a counselling service, Professor Holmes, and that's what we are doing, helping him deal with the stresses and strains of being a medical student."

"Well, I am glad you've called, and that he is finally getting some help. Was there anything else you wanted to know? If you need anything else, please do not hesitate to contact me again."

"No, I think this will be all. Thank you for your time."

"You are most welcome. You sound awfully young for an occupational health physician, but perhaps my age is beginning to show in my deductions. Good day, Doctor Willis."  
  


___________

Putting the receiver down, Sebastian draws a deep breath, grinning. Yet even in his triumph, astonishment over what he's learned — and how easily — is making him oddly cautious now that the deed is done, and the adrenaline is dissipating.

Everything he's suspected, everything that should be rather obvious in hindsight, is true.

The best he'd been hoping for was some milder dirt about Holmes' past and maybe a diagnosis combined with parental connections to some big players at Cambridge to ensure a place for Holmes could be arranged behind the scenes. What he'd actually got was so much better — and offered up on an unsuspecting silver platter by Holmes' mother.

He's going to teach that idiot a lesson about humiliating others, and what he's learned today will allow him to do it in a way that will render Holmes utterly defenceless. _Speak up, and your secret will be known by the whole damned world._ Holmes' big mouth can't be all down to some developmental deficiency, can it? He's vile, arrogant and makes no secret of the fact that he thinks everyone else is of inferior intelligence. That's not how autistic people usually are at all, is it? _Aren't they supposed to be quiet and obsessed with things and keep to themselves and freak out easily?_ Well, that last part seems to partly apply to Holmes, judging by the nervousness at the oddest things, but… maybe there _are_ things his mother hadn't revealed. Wilkes would have banked his money on some antisocial personality disorder rather than autism, but the precise words don't matter, do they? He has plenty enough to demonstrate to the arrogant prick that he can't hide or escape the truth, which should have closed the gates to medicine for him long ago.

Holmes' mother seems very much a realist about his chances of succeeding. Sebastian has no idea why the faculty staff haven't interfered in his attempt to become a travesty of a doctor years ago. That's why he rather thinks he should be congratulated. He's doing what the university should have done long ago — right after those first weeks at anatomy lab when Holmes had given everyone a taste of what he was like. Sebastian's blood boils still as he recalls the humiliation of being told he wouldn't be allowed to dissect more with Holmes standing right next to the teacher, that venomous smile on his face…

All the other students have smelled it on Holmes that he has a screw loose, and it's utterly unfair that anyone should be paired with him for clinical courses — he makes even his study partners look bad. Sebastian has no interest in psychiatry, but he's been reading up on their instructors' research for each clinic day so that at least one of them might make a good impression. He hates that his efforts might reflect well on Holmes by extension. During previous clinical courses, the berk has made a sport of correcting their teachers whenever possible, so it's been as annoying as it has been fascinating to witness how Holmes seems suddenly and completely on the wrong footing. He might know the theory, which he seems to have memorised even before a course starts, but he's making an utter hash of the clinical sessions. Psychiatry appears to befuddle him completely, which is logical against the backdrop of the autism.

_Sherlock has no idea how to deal with people. Autistic people don't even like other people, do they? They're only needed as an audience for their nonsensical interests._

One of those seems to be enjoying cutting people up, regardless of whether they are dead or alive. _That's why he must have wanted to evict me from dissecting our cadaver — the creep wanted it all to himself, and that's why he wants to be a surgeon!_ Wilkes can't think of a reason why else Holmes would choose a clinical specialty except that it would allow him to wield a scalpel. _Must be a serial killer in the making_.

It suddenly occurs to him to wonder whether Holmes' squeamishness about psychiatry comes from personal experience. His diagnoses must mean he's been assessed by professionals, and his mother had mentioned there had been many therapists! _The thought is …delicious_. _And it explains a lot_.

Two days prior, they'd attended a compulsory introductory visit to a unit delivering ECT treatment — electroconvulsive therapy. Sebastian had found it quite fascinating how something that used to be the stuff of horror films had become an evidence-based part of modern psychiatry. It was so much less anticlimactic than one would assume; these days, patients were given a short general anaesthesia with a muscle relaxant to spare them from remembering the electricity and the following seizure, and the relaxant prevents muscle aches. Of course, it was always unpleasant to observe a patient having a grand mal fit but knowing that it was purposefully produced had put Sebastian at ease.

Not Holmes, though. He had seemed outstandingly disturbed by the very concept of the treatment.

They'd been assigned to talk to one of the patients coming in for a monthly long-term upkeep appointment. The patient was a twenty-seven-year-old man, a cellist by profession. When struck down by a severe phase in his long-term depression, he couldn't even manage to eat or maintain personal hygiene, let alone play. With ECT, he told the two students, he could make music and look after himself, and he seemed very happy with the efficacy of the treatment. The only hitch was that the memory issues which were a common side effect of the treatment prevented him from learning new pieces and playing in the orchestra which used to be his employer. He now worked as a salesperson in a hardware store.

"But is it truly worth it if you can't play, if you can't do what you most want to do?" Holmes has asked the patient quietly after keeping silent through most of the conversation.

"Well, it's got to be better than death or catatonia," Sebastian had interjected.

The patient had shrugged. "Nothing else has given results as long-lasting as this."

The team had been ready for the patient, then, and Sebastian and Holmes had followed him into the procedure room. They'd watched as monitoring equipment was installed, electrodes attached to the patient's forehead and the impedance of the treatment unit tested. Holmes remained standing in a corner by the door, watching the proceedings warily. Sebastian had been closer to the action and had been allowed to start the necessary IV on the patient. He'd got it in on the first try. The anaesthesia team then administered a drug cocktail which they'd been told was tailored for each patient and took effect quickly. The muscle relaxant took effect fast, too, making the patient's eyelids, thumbs and diaphragm twitch before he went completely lax.

Once the electricity had been administered, a forty-second seizure took place, after which the anaesthetist removed the tooth guard and began ventilating the patient with a bag-mask combination.

"How familiar are you with the indications for ECT?" The psychiatry registrar administering the treatment asked the two students.

"It's used in drug-resistant or otherwise severe adult, and adolescent cases of depression, psychoses and mania," Sebastian had rattled off. "Can it be administered if a patient is pregnant?"

"Yes," the registrar responded. "It's actually much safer for the foetus than many drug regimes. It's also infrequently used in children."

"For what?" Holmes piped up from his corner where he was standing with his arms defensively crossed.

"It's actually underused, considering its efficacy and safety. As you probably know by now, there are diagnoses which are not commonly assigned to children since their symptomology can still be developing, but disorders with psychotic features and severe depression are common indications in children. It's also been used quite effectively in autistic children with severe behavioural issues."

"Why?" Holmes asked, his gaze fixed on the still-sleeping patient. He sounded apprehensive, almost… upset.

Wilkes had assumed that the whole concept of ECT just bothered him for some reason, but in hindsight, his unease seemed to increase during that part of the conversation. "What on earth do you mean, 'why'?" Sebastian had scoffed. "It _works_ , Sherlock."

The registrar finished jotting something down on the patient's treatment card. "Especially in self-harming autistic children and teenagers, symptoms are greatly decreased after ECT. It's far from a first-line treatment, of course."

"How do they decrease? ECT is indiscriminate, isn't it? The seizure is a spreading cortical depression which can't very precisely affect just some parts of the brain? Isn't it like… like… removing an entire limb to treat a wound on a toe?"

Sebastian had rolled his eyes. "Sometimes you _do_ have to amputate a limb when there's gangrene."

"Patients describe the effect as calming, re-centring. Very effective for catatonia," the registrar explains.

"It's never voluntary, is it?" Holmes asked, watching the patient on the trolley slowly waking up and prying their eyes open.

"It can be. We have many patients who have agreed to ECT as a periodic upkeep treatment because it works for them."

"But it's not specific to any neural centre specific to such behaviour as self-half. It doesn't address _why_ patients do such things," Holmes insisted. "It can't."

"What does it matter?" Sebastian had snapped. "Catatonia and depression are _symptoms_ of a _disease_. You don't go around asking your precious brain tumours why they cause seizures, do you?"

That had shut Holmes up. After talking to the mother, Wilkes can now put two and two together: Holmes doesn't seem to understand or accept the concept of involuntary or very involved treatment for psychiatric illnesses being necessary and being told ECT could be used to treat what he had seemed to have struck a nerve. Holmes watched, blinking oddly, as the next patient being treated, and then excused himself to go to the toilet when the procedure room was being cleaned.

Sebastian did not see him again that day. _So rude._ Holmes had just left without saying thank-you and goodbye to their supervisors. It seemed typical of his blundering manners. If the staff think he's a weirdo and all the other students hate him, there's no way he'd be able to practice without a constant barrage of complaints from patients and staff and… everyone. Sebastian wouldn't want to admit he knew such a doctor, so how could Cambridge risk its reputation and let Holmes get on? They must have noticed he's… all that. _Autistic._ _Who the hell has even heard of an autistic doctor?_

Sebastian skims the notes he'd made during the call to Holmes' mother. He may have to invent some details to make it sound like he's done a thorough interviewing and examining job, but that won't be an issue. He realises he should still have that practice questionnaire they'd gone through during a group teaching session which should give him enough of Holmes' background information to make up for ground not covered during the conversation with the mother. By making Holmes into one of his portfolio cases, Sebastian can expose the truth, make it public. Of course, as with all portfolio cases offered by students for assessment, the name would be anonymised, but he knows that Holmes won't dare question anything in public, or he'd risk exposing the truth to everyone — students and teachers alike. He'll have to hear the truth in front of others — and accept it.

When he'd told the idiot that it would make his fucking day when the day of reckoning came, Sebastian is certain he's not the only one feeling that sentiment. It will make the day of a lot of people — students and teachers alike — to see Holmes leave Cambridge. After what Sebastian is planning, Holmes will do it even of his own accord, too humiliated to continue.

Sebastian is _so_ looking forward to rendering the sharp-tongued, fumbling imbecile utterly _speechless_.


	11. So Proud of You

During the psychiatry course, each student must present two cases selected from the patients they have encountered during their clinical placements. David Wright, the rugby captain, has just given a rather lacklustre account of a bipolar patient with no distinctive features at all. Sherlock suspects he'd picked it last minute and not because he considered the case very interesting; the dates on his slides reveal that he'd seen the patient on the last day before the written reports were due. Sherlock knows David wants to be an orthopaedist, so perhaps he considers the world of psychiatry as dull and pointless as he does.

"Any other comments or questions for David?" the teacher in charge of their case seminars asks. "If not, then we'll move on to Sherlock's first case."

He gathers his notes and stands up, then walks to the front of the seminar room. Wilkes is whispering something conspiratorially with Tasha Caines, who looks rather bored. She has already presented both her cases in the earlier sessions of the week. While the first one had been well-done, the second one had been even more impressive: a very thorough and intelligent analysis of a patient with schizotypal personality disorder, with a concise and demonstrative explanation of the differential diagnosis between that and schizophrenia. To focus on the diagnostic process had been one of the instructions they'd been given.

He needs to focus. The teacher is looking at him expectantly, but Wilkes leans back in his chair and stretches his neck theatrically just as Sherlock clears his throat. Not for the first time, he briefly wonders why that particular student grates so much on his nerves just by existing. Why is he even paying attention to Sebastian?

"Go ahead," the instructor prompts.

Sherlock shoves his USB stick into the computer and opens his presentation. "My case is from the acute intake ward. A 36-year-old Caucasian male, a Polish construction worker by trade, was brought to the Addenbrookes A&E department by his wife because he'd been sent home due to increasingly erratic behaviour. With the help of a translator, it was established that he'd had a psychiatric assessment because of paranoid symptoms four months prior in Warsaw — just before accepting the job offer here and expatriating with his family. In Warsaw, he had been prescribed low-dose risperidone which he had been taking regularly according to his wife. He is somatically healthy, uses very little alcohol, and the risperidone is the only regular medication he takes. In the course of the week prior to the A&E visit, he had been witnessed by co-workers talking to himself and swatting at invisible things. His mood had also deteriorated to irritable and distracted."

Sherlock looks up from his notes. The other students are showing at least mild interest. _Good_. He hasn't got to the juicy bits yet.

"The physical examination showed no pathological neurological findings, though it must be said that, judging by the notes, the neurological status performed was not as thorough as emergency medicine guidelines recommend. There were no signs of infection. Thyroid hormone levels were normal, tox screen and drug panels clear. CT or MRI imaging was not deemed necessary due to the lack of physical findings and a four-month history of psychiatric symptoms, and the patient was referred to the psychiatric crisis team. He was co-operative and accepting of treatment, so an involuntary hold was not considered."

Sherlock then goes on to detail what antipsychotic medications were added to the patient's treatment regime and that the patient had been transferred to the acute intake ward as a voluntary admission.

"On the third day — two days before Sebastian Wilkes and I interviewed and examined him — the patient began complaining about a headache and suffered a seizure. A CT scan was performed; a spinal tap was considered but after the CT scan results came through, obtaining a spinal fluid sample turned out to be both unnecessary and contraindicated. What the CT showed––" Sherlock shifts to the next slide, "––was a homogenously enhancing mass lesion in the left lateral ventricle associated with ventriculomegaly and a midline shift. Most likely, the headache and seizure were the results of the tumour blocking the Aqueduct of Sylvius and raising intracranial pressure. Our physical examination showed bilateral papilloedema, but no other focal neurological deficits. An urgent referral to the neurosurgical service was made, but for lack of a free bed at the ward, he remained at the psychiatric intake ward. At that point, he'd been there for eight days."

"Was he angry that there was such a delay in reaching the diagnosis?" Tasha asks.

"No. It had been explained to him why a CT had not been done, and it was reasonable to assume that when he'd sought help in Warsaw, no neurological deficits had been found since they were non-existent at his intake here. However, if they'd dug out an ophthalmoscope at the Addenbrookes A&E, perhaps the diagnosis would have been reached quicker."

"How many of you would have examined his eyes at A&E?" The teacher asks. No hands are raised, and Sherlock keeps his still as well.

"There was no reason to do so since he was manifesting no symptoms indicative of raised intracranial pressure," he explains rapid-fire. "Hindsight is always 20/20, of course."

He feels more at ease, now. This is his territory, what he excels at: concrete things, tangible answers, logical causality between symptoms and physical findings. "However, it can be argued that _visual_ hallucinations would be a reason to order a CT to rule out secondary psychosis. Pity that the patient only admitted to those at the ward, not at intake, or maybe there was something lost in translation."

"And why is the nature of hallucinations significant?" The teacher asks in an encouraging tone.

"Auditory hallucinations are typical of psychiatric illnesses, while visual hallucinations can be a feature of organic intracranial pathology. While rare, there have been numerous case reports of patients representing with only psychotic symptoms with a brain tumour as an underlying cause, and their symptoms have resolved once the tumour has been removed."

"How can we tell whether a patient's symptoms were caused by the tumour or by a comorbid psychotic disorder?" The teacher asks.

"Easy," Sherlock quips. "Take out the tumour and see if the symptoms resolve. A stereotactic biopsy showed this patient had a neurocytoma, and with its well-defined margins and good prognosis and sufficient distance from vital centres, it was considered operable. The tumour has since been removed, and four days later, the patient was tired but hallucination-free."

Sherlock had established this himself. "I visited the man at the ward, and conducting a thorough neurological examination, complete with a structured psychotic symptom questionnaire."

"Did you have a translator with you?" David asks.

Sherlock shakes his head. "I taught myself the pertinent questions and potential answers in Polish. Now, regarding the surgical technique––"

"Thank you, Sherlock," the teacher interrupts.

He's confused. He hasn't used up all his time yet. "But I was going to explain about the removal?"

"We need to keep the focus in the psychiatric aspects of the case," the teacher explains to him.

In the back of the room, Wilkes is wearing a grin laced with schadenfreude as he leans close to Tasha yet again to remark something.

Sherlock's eyes narrow. Wilkes has such a juvenile habit of gossiping at the back of the class as though they are still schoolchildren. He is almost tempted to mention the fact that his erstwhile partner on the case had not even been present during their examinations of the brain tumour patient because he'd been in the loo throwing up due to a monumental hangover.

Anwar speaks up. "You mentioned other case reports? What other kinds of psychotic symptoms can brain tumour patients have? It's kind of scary to think a tumour might be missed when there are no clear physical findings."

"As I explained, the distinction between auditory and visual hallucinations appears to be a key factor," Sherlock replies. "Frontal lobe tumours are known to cause personality changes and erratic behaviour; in one case a religious woman developed religiously-themed auditory hallucinations which prompted her to self-harm. There is also a reported association of posterior fossa tumours with neuropsychiatric symptoms; most likely the cause is a disruption of the cerebellar output to mesiodopaminergic areas, locus coeruleus and raphe nuclei or changes in the function of thalamolimbic circuits by cerebellar lesions."

"How would you summarise the take-home message of this case?" The teacher asks.

"It goes to show that not all brain tumours present with the classic symptoms of seizures or headaches, and that care must be taken to rule out organic reasons in patients with new and unusual psychotic symptoms."

"Very good, Sherlock. Any other questions?"

There are none, so he can return to his seat, relieved and triumphant. He knows he's done well, even if he wasn't allowed to present the surgical details. He had been able to answer every question, and he knows he'd been thorough; moreover, his presentation had followed all the structural guidelines. These assignments will be graded, and they have a surprising amount of weight in the final marks of this entire course. It's a chance for him to compensate for some of his failures.

Arabella's presentation is next. Sherlock doesn't expect her to provide a very interesting case; she seems to be a chronic under-achiever. However, when she begins recounting the patient's first A&E visit, Sherlock's interest is piqued. It all sounds eerily familiar.

By the time she gets to describing what had been discovered during the second visit — the consequence of a suicide attempt — Sherlock is certain he has also encountered the patient.

"She had extensive scarring and some recent, superficial, pocket-knife-inflicted wounds on her upper thighs, stomach and breasts. In the presence of her mother, she wouldn't talk to us, but when alone with the Consultant and us, we learned that she had confided in a friend something bad and that friend had shared it with some of the other girls in the class. As a result, she'd been cast out of the group and bullied. She wouldn't tell us what it was, but at the adolescent psychiatric intake ward, she told one of the nurses that it was about feeling that she wasn't really a girl. It turned out she seems to be transgender."

Sherlock is irritated by the manner in which Arabella is explaining the case; she sounds more like gossiping with a friend than presenting a medical case.

"How did she attempt suicide?" He asks, interrupting her explanation of the medications the patient had been put on.

"She cut her wrist open."

Should he reveal that it could all have been prevented if that earlier visit had gone differently? It never seems to go down well in these case conferences if he criticises senior colleagues or his fellow medical students. _Doctors make mistakes all the time; how will they learn from them if they're just swept under the carpet? Does it serve anyone not to call them out on their lacking knowledge and offhand management of patients?_

Keeping in mind that the patient's mother had already threatened to make a complaint about him, Sherlock decides that his need not to draw any unnecessary attention to himself wins over his righteous indignation on the patient's behalf. He stays silent, finding some consolation in the fact that if his indiscrete questioning of Phoebe does get brought to the attention of the Course Leader and other faculty staff, he now has the perfect defence: he had been right.

"How did the parents take the news, do you know?" The teacher asks.

"There was an argument at the family meeting between the Registrar and the mother. The mother wouldn't accept the transgender thing as an explanation. She said that the patient was just acting like a typical teenager who wants attention."

David scoffs. "Yeah, because every teenager slashes their wrists to try to kill themselves."

"What could you tell us about the risks to mental health of being transgender or a member of a sexual minority?" The teacher asks.

Arabella looks at her ballet flats and purses her lips. "I guess… they probably have a higher suicide risk?" She suggests.

"They certainly do," the teacher confirms. "There is a logical trigger here for the suicide attempt, wouldn't you agree?" There are nods around the room. "We have a mother domineering the conversation during the initial visit who appears dismissive of the patient's view of her issues, and we have bullying and loss of peer support and friendship."

"Kids can be very cruel," Tasha says.

Sherlock couldn't agree more. _And medical students are hardly any better._

It doesn't give him any pleasure that he'd been right about Phoebe's self-harm, and that an outpatient approach which allowed the mother to run the show had been the wrong plan. He knows from experience that allowing an adult like that to speak for all concerned, to call the shots, to demand all the attention, will just mean that the patient will not be listened to or believed or respected or treated like a human being. He can't understand why psychiatrists have not realised this. _Why can't they put parents like that in their place? Are they rendered so toothless by fear of complaints?_

Sherlock is relieved to hear that after two weeks at the acute adolescent ward, Phoebe is doing much better. She's made a friend in a fellow patient who happens to live quite close to Phoebe's family home, and she's engaging in therapy.

Phoebe's story makes Sherlock decide that he's never going to shy away from speaking the truth when it comes to patients. He makes a vow that he'll always pay attention to them and not some idiot relative trying to steamroller over everyone and that he won't let a threat of some imbecilic complaints keep him from doing right by a patient.

_____________

While not feeling entirely relaxed, Sherlock does leave the session in a better mood than in weeks. He stops by at a pub for some chips and a glass of water and eats his meal slowly while reading a paperback of the biography of a well-known Russian neuroscientist he'd picked up at Heffers the week before.

A chilly mist hangs on the streets as he makes his way home at sunset. His room is dark, chilly and uninviting when he walks in and drops the keys on his desk. A hot bath is in order before catching up on what he'd planned to cram tonight.

When he's about to make for the bathroom, there's a knock on the door — it's a student he barely knows telling him he has a phone call. Just occasionally one of the clinicians will telephone about a last-minute change in his schedule of placements, but it's rare. It's likely to be his mother again since nobody else really calls him. His father seems to think that Mummy keeps in touch often enough that he can just get the news from her, and the two brothers rarely have a reason to call each other.

While the logical side of his brain makes the connection quickly that it must be his mother, another part of him still hopes, every time, despite his better judgement and knowledge that it might be Victor. Sherlock had been the one to walk away, so it seems unlikely that Victor would want to be in touch; he had always had many other friends and acquaintances to turn to. Sherlock tries to remind himself that friendships are flimsy, at best, in the world where drugs are the most important thing in anyone's life. Most likely, Victor hasn't spared a thought for him since their friendship deteriorated.

_But what if it really is Victor, who's now clean and wants to see me?_

As much as Sherlock tries to tell himself he has no use for the company of other people because they're idiots, he'd once had a friend, and he misses that. He misses having someone to talk to, someone who actually enjoys his company instead of having to endure it because Sherlock is related to them.

But… if the caller _were_ Victor, one day, what could Sherlock say to him? He can't even decide whether and how much he regrets leaving Victor behind. Certainly, his life has taken more constructive turns since that day, but could there have been a way to fix it or a way to change things without cutting ties?

He grabs his keys, hurries down the corridor and picks up the receiver, heart fluttering against his ribcage. _It's not Victor. Don't be stupid and sentimental._

Hearing his mother's voice is still a disappointment.

"William!"

"Mummy."

"I tried to ring before, where were you?"

"At the pub."

"At the _pub_? Was it someone's birthday?"

"Why would it be––" He huffs. Couldn't he go to a pub without being forced to do so because of some arbitrary social function others pressured him into attending? He couldn't remember a single time he'd been invited to anyone's birthday festivities. When he was a child, they always just celebrated within the family because Sherlock couldn't tolerate many of the features of a typical children's birthday party: noise, balloons, lots of other children.

"William?"

"Never mind."

"Your father says hello; he's gone to replace our lawnmower from the garden centre before it closes. Getting that old one repaired would cost too much, considering it's as good as scrap metal, at least that's what Nigel — you remember Nigel, they live two houses over, the wife breeds cocker spaniels — what Nigel says. He understands these things."

"Riveting."

"Anyway, I called to tell you how happy I was to hear you've come to your senses. I'm so proud of you, William, for finally getting the help you need! Who knows, maybe it'll enable you to manage your studies better. I'm hardly surprised to hear you were having difficulties, but I didn't know this semester was so outstandingly challenging."

Sherlock's brows knit together. This is confusing even by the standards of his mother's usual, florid nonsense. He doesn't even want to ask her what this is about, doesn't want to encourage her misguided fussing. It's just that something is making alarm bells go off in his head.

She'd said she'd _heard_ something. From whom? "I don't understand. What are you on about?"

"That nice doctor who called from… was it Student Support Services? No, that's not it, what was it they call it… Student Services Centre, I think. Not a very marketable name, is it? Doesn't really say what it's for. Come to think of it, perhaps he was from the counselling services. That's not the same place, is it?"

"What the _hell_ are you talking about?" Sherlock is gripping the receiver in both hands, breathing hard as anger flares up. His mother has been pestering him ever since he'd begun studying medicine that he should _declare his disability_ , should seek counselling and subject himself to other such degrading nonsense. _Over my dead body_. Has she gone against his explicit, strongly worded and several times repeated wishes by talking to someone at Cambridge? _How dare she!_

"Why would they call you?" Sherlock demands. "What have you _done_?!"

His raised voice gains him a wary glance from the Porter who's seated in a corner desk nearby. The phone is in a booth which does little to mute the voice of the person using it.

"I've not done anything, dear!" Violet Holmes replies indignantly. "They called _me_. I cannot fathom why it took you so long to seek help. They're obviously very dedicated to students' well-being since they are this thorough."

Light-headed with shock and confusion, Sherlock leans against the wall next to the phone. _She must be lying to him about someone contacting her and not vice versa_. He wouldn't put that past her. When she gets it in her head that he can't be left to his own devices, that he can't be allowed to manage on his own, there's no stone she wouldn't turn, no ruthless stunt she wouldn't pull to walk all over him. He'd thought that leaving for Cambridge would finally break her hold over him, but he should have known that extending her tendrils all the way to Cambridge would be no problem at all. Even if he moved to the north pole or the bloody moon, she'd find a way to try to micromanage his life.

_Is this happening because I let slip that I don't like this psychiatry course?_ He's going to pick apart her lies and then he's going to shut this down and not talk to her for a while. It's the only leverage he has with her: communication. 

"Who… who did you say you talked to?"

He hears the rustling of paper; she must be digging out the notepad she keeps beside the phone in the hall. "A Doctor Willis. He was very nice, though he sounded quite young. Oh, I did write it down — he _was_ from the Student Counselling Service. He wanted to interview me on the phone about some background information, about your diagnoses and such."

Sherlock knows the rules because he's quoted them to his mother countless times. The student support services — any branch of them — _cannot_ act unless a student declares a disability or seeks counselling. Unless a student is classed as a vulnerable adult, a parent cannot do such things on their behalf.

"He didn't really call you, did he?" Sherlock accuses. "Just tell me. What did you _do_?"

" _William_. I know you don't want to discuss such things with me, but you don't have to pretend it's not true. I'm so _proud_ of you for doing this! Of course, we have been sceptical of this whole medical school idea, and this doctor seemed to agree that it's quite a formidable challenge for someone like you, but with the right help, maybe you could graduate and then find a job suited for your limitations. Maybe something in pathology or a pharmaceutical company, perhaps? I'm sure Mycroft would love to advise you on such applications — did you know he's made it into management, now?"

Sherlock doesn't register a word of this because he's too busy frantically trying to understand what is going on. His mother has always been up-front — gloating, even — about the ways in which she's interfered in her life and shoved whatever help she has deemed necessary down his throat. Something tells him she wouldn't lie about this, and the fact remains that even if she had contacted someone at Cambridge, they would not have moved forward or disclosed anything to her without his explicit permission. _Somehow, she really does seem convinced this is my doing, but it doesn't make any sense!_ It's not as if he has sleepwalked into a student counsellor's office or had some fugue during which he'd declared that he was on the Spectrum.

The key question is: who is _Doctor Willis_ , and what business would he have contacting his mother? Who would have a motive to poke into his personal life and his medical history? Who would know enough about him to fool even his mother into thinking they were already familiar with him?

_Who the hell is this Willis? Why would they take such initiative in––_

Suddenly, it all connects.

_The pair exercise. The one with the mock psychiatric interview._ Sherlock had tried not to reveal anything, tried to stick to neutral facts about his family and his school history. It would still be enough to trick someone into thinking he'd revealed those things in another sort of confidential interview.

_There is only one who could be a big enough idiot not even to invent an alias that would be significantly different from their real name._

He slams down the receiver in panic, not even realising he'd just hung up on his mother. The phone soon begins ringing again, but he ignores it. He runs back down the corridor, locks the door behind him and drops to the floor. He gathers up his knees and hugs them tight into his chest, his heart lurching uncomfortably up his throat when it's not beating a manic staccato against his ribs.

All he can now think of is a name — the final puzzle piece, the adversary at the centre of the coliseum, the Minotaur in the centre of the labyrinth, the walls of which are closing in on him.

_Sebastian Wilkes._


	12. Patient X

Sherlock paces all night, analysing from every angle what he has learned. His increasing anxiety keeps interfering with his brain work, and the stakes are high: he needs to work out what, exactly, Sebastian Wilkes intends to do with the information he's gathered. The bastard can't go to the faculty because that would raise the question of how he has come to have Sherlock's private medical information. Any misconduct based on a disability issue would put laws and regulations on Sherlock's side very firmly and make Wilkes look like a discriminatory busybody. But, it would also be mortifying for Sherlock, and that's precisely what Wilkes would want the most, what he's willing to risk.

No, this can't be about Wilkes being some sort of a whistle-blower for the faculty. Whatever is going on is _personal_ , which Wilkes' plan will reflect. This has to be about teaching Sherlock a lesson. But how will that lesson be delivered? Sebastian can't exactly ruin his reputation because it's not very good to start with. He can't ruin it publicly, because that would raise the question of how he has acquired such data.

Sherlock inhales, fingers steepled together under his chin and he pivots on his heel by the window, continues wearing a trench into the floor. He knows he's going round in circles, bordering on ruminating, but the clock is ticking, and he needs to solve this to get ahead of Wilkes in defusing whatever proverbial bomb he's constructing.

_How would Wilkes make this public enough to be humiliating, while simultaneously not revealing his own role?_

Suddenly, it all fits together. A gasped 'oh' escaped Sherlock's lips as he deflates into a chair.

 _The case seminar. Wilkes has one case left._ The patients are kept anonymous. Nobody will know who is being discussed — apart from Wilkes and patient, _who will be present_.

Adrenaline surges in, both from the triumph of having cracked the mystery and from the sudden anticipation of disaster and embarrassment.

 _I can't attend that case seminar_.

But then he'd have to explain why. He'd need to do remedial work. Wilkes would gloat. Wilkes would _win_ , one way or the other. And it disturbs Sherlock only marginally less to imagine him delivering that presentation to the others without him there. In fact, it would drive him barmy not to know what the bastard had said.

_What if I intercept Wilkes before the session?_

And say or do what, exactly? If Sebastian has already taken huge risks in putting it all together and he knows Sherlock will know that he knows that Sherlock knows… he is unlikely to back down. That gives Wilkes the upper hand — knowing that Sherlock is rattled enough to try to beg him not to do this. _Once again, he'd win. He'd make me grovel, and I'll not do that. I can't. I won't._

The realisation is sobering: _I have to attend the seminar and not react_.

Could he? Could he listen to all of it being put plainly, as though discussing just another psychiatric patient? All his secrets, descriptions of his family and his childhood, the truth of his diagnosis laid bare?

There is no other option, he realises after approaching the subject from every angle. He's smoked eleven cigarettes, and it's now dark outside.

He must go to the seminar and listen as though he has no idea whatsoever who Wilkes is presenting about. He has to behave as though it's not him.

He's not sure he can manage that at all.

 _Sebastian can't be allowed to win_ , unless… _he has already done that?_

Did Wilkes and everyone else who has ever tried to warn Sherlock off medical studies win the moment he set foot in Cambridge?

Is this the inevitable failure come to pass?

_______________

Theatrically, Wilkes taps his notes on the desk in front of the seminar room to arrange them neatly. He looks focused, determined, keener than he ever does at these things. Usually, he seems to want to project an air of mildly bored responsibility as though being seen as one of the more conscientious students in the year class would ruin his reputation.

Sherlock is in the back row. He's certain anyone could read on his face right now how he wants to flee. He has to sit on his hands lest he starts to gnaw on his nails or pick at his cuticles until they bleed.

"The second case I am presenting…" Wilkes starts grandiosely, giving Sherlock a very short glance.

Sherlock realises he hadn't said 'my patient' like the other students upon presenting their cases.

"…is an exercise in the differential diagnosis of a patient who is not yet in an acute phase. As we know from Doctor Sarraf's's excellent lectures, stable patients pose challenges for psychiatric analysis and treatment because they have the self-awareness to regulate what they present to clinicians. This patient will provide a very good example of how patients can make a physician's duty difficult to fulfil, and it will allow a number of the themes that we've been exploring this term to come to light in a clinical setting."

Sherlock is suppressing his urge to roll his eyes at Wilkes' grandiose statement and the icing on it of sucking up to the teaching staff. Struggling to stifle the urge to stim, he forces himself to focus as Wilkes continues.

"The case is a twenty-three-year-old male who presented during a session at the University Counselling Service, directed there by his college Director of Studies, who had become concerned about his behaviour. I did a stint there as a volunteer."

So, that's where Wilkes had come up with the idea of scamming his mother into talking to him. _What a bastard._ Knowing Wilkes, he would have been conniving enough actually to have done the volunteer work to cover his tracks. No one would argue about it or ask for written confirmation because counselling sessions were confidential, and since they're not a part of the course curriculum teachers would be uninterested in checking attendance.

"He'd been referred to the centre following a number of reports from his placement instructors for inappropriate, often bizarre behaviour that was unsuitable for his chosen field."

"And what was that?" The teacher asks.

"Law," Wilkes answers after the briefest moment of hesitation. "His course unit this term was criminal law, which involves a number of placements in the various stages of the justice system — it's not that different from the way we medical students are placed in clinical settings." Wilkes clears his throat and puts up his first PowerPoint slide, entitled _'The Uncooperative Patient_ '.

"The individual was visibly a reluctant participant in the counselling session, not seeing the value of discussing his interpersonal conduct. A partial history was extracted using standard questionnaires. According to him, there were no chronic health issues, and he wasn't on any medications. He denied any developmental deviations, and became hostile when inquired further about that, asserting he had not been, I quote, 'a juvenile delinquent'."

 _The prick!_ He's using that questionnaire exercise they had done in class. Sherlock desperately tries to remember exactly what he'd said, and how it could be misconstrued, based on what his mother had unwittingly told Wilkes.

"It was about then that I began to pick up on the non-verbal clues that he was lying. When pressed about where he went to school, he named a location but did not admit to something which I later learned from his family — that he'd been home-schooled due to severe difficulties in peer relationships. Similarly, he lied when asked why he was a year older than the rest of his cohort, coming up with a story about a gap year. It was then that I became suspicious of his answers to questions regarding any previous psychiatric diagnoses or drug abuse, both of which he denied."

"When I raised with him the issues that the Director of Studies had forwarded to the Counselling Service, the patient became agitated."

Smugly, Wilkes is watching him; Sherlock sets his jaw and glares back. They both know what's going on, and Wilkes is clearly relishing it.

The teacher interrupts. "Mister Wilkes, your written portfolio contains a number of these incidents in considerable detail, but could you summarise some for the class that you think are indicative of the problem? We need context."

Sherlock has no doubt that his being paired with Wilkes will have given him ample opportunity to gather data and then twist it, fabricating things in order to suit his desire for revenge. He feels nauseated and briefly wonders if he's going to have to leave in order to be sick. _Stick it out_ , he tells himself, trying to steel his nerves. _I need to know the worst._

"Right — some specifics." Wilkes actually rubs his hands gleefully. "During a mock police interrogation exercise, the patient accused his client of being a con artist who was gaming the system to ensure he was incarcerated rather than continue being homeless on the street. The situation escalated into violence, with the patient being physically assaulted by the client. In the post-session discussion with the teaching assistant, the patient expressed surprise at being taken to task for conduct unbecoming to the legal profession. Apparently, he had no idea that insulting the man and provoking him to violence wasn't part of his responsibilities as a lawyer."

Several classmates chuckle out loud. Wilkes milks their mirth, repeating, "He really had no idea."

Wilkes is soon strutting in front of a new slide, this one entitled ' _Inappropriate Behaviour'_.

"In another incident, the patient was reported for distressing a minor during a practical placement. She'd been brought in by the police because she was walking down the middle of a road, obstructing traffic. The student, together with an instructor, was to provide judicial advice regarding her rights. The patient failed in his duty to protect the minor by making inappropriate references to self-harming as a form of attention seeking. He actually asked her to lift her skirt in the presence of others, demanding she show him her thighs. The girl's mother was outraged and considered making a formal complaint."

There is disquiet in the room; a number of the female students appear to be uncomfortable. Tasha Caines speaks out, "That's misogynist behaviour; wouldn't have said that if it had been a bloke."

Sherlock wants desperately to say that it wasn't that way at all, but of course, he can't. He just has to sit there and take this evisceration. 

"When this catalogue of misconduct and odd behaviour detailed further in my written report came to light, I began to consider whether the patient was exhibiting signs of DSM 301.7 — antisocial behaviour disorder — or 301.87, borderline personality disorder."

"At first, I tried using the DSM's multiaxial differential diagnosis — looking at clinical aspects, then the personality disorder features, followed by any medical conditions and lastly, the environmental and psychosocial aspects of the behaviour. To say the patient was unwilling to engage is putting it mildly. So, I went elsewhere on my hunt for further diagnostic clues."

Wilkes is a showman, and his ridiculous pandering to the audience adds fuel to the bonfire of Sherlock's rage. There is an implied sneer, an air of projected superiority coming from the student that is incendiary. _How dare he treat anyone with such disrespect? Describing the patient as a conniving liar is hardly the way to present a case._

The other students in the room seem to be hanging on every word.

Up comes a slide with the two DSM-IV categories side by side. "Discussions with his classmates who have observed his social interaction at college indicated he was unengaged and uninterested in interactions with others, his behaviour being rude and inappropriate, even hostile at times. The view was almost universal that the patient was totally unsuited for the sort of interpersonal skills that a legal career requires."

"However…" Wilkes pauses, presumably for dramatic effect. "I got nowhere in discussion with the patient, who was determined to perpetuate the lies he'd given in the first interview. As Doctor Sarraf showed us in our seminar, the uncooperative patient requires a different approach to patient history. With the patient's consent, I contacted his family and some of his fellow students to see whether my initial assessment was correct and to form a picture I already explained about regarding his peer relations."

Sherlock seethes. _Lies? Talk about_ _lies_ … Whatever deflections he'd given in the class on that questionnaire, what about the biggest lie of all — the consent which Wilkes never got? Everything he has done in this assignment is against every rule of medical ethics, let alone the academic regulations about this needing to be a real case. It's a load of tosh, total fabrication, but Wilkes knows he's going to get away with it, because to protest or report him would mean Sherlock would have to disclose the truth about himself, contradicting the details presented when he'd first applied to medical school.

Shell-shocked at how awful all this is, Sherlock can only sit back and wait for the rest of it; he knows what is coming, given what his mother had said. His hands shake where he has hidden them between his back and the chair. He's surprised at his lack of fury towards his mother, perhaps caused by the paralysing anxiety he's feeling; he realises now that she'd been duped just as their classmates are being misled right now. Sherlock hates her willingness to reveal his medical history in this manner, but it's hardly out-of-character for Violet Holmes.

He feels distant, out of himself. Unreal. How often does a person get to experience what they most fear in the world? Every sneer, every word, every glance from Wilkes in his direction seems to cut a pound of flesh out of him. What will be left once this vivisection is done?

Wilkes clears his throat. "Classmates considered his behaviour antisocial, but the DSM-IV criteria are quite specific — that the patient needs to be manipulative and willing to use charm to secure their objectives. The more I looked at the two personality disorders, the less convinced I was. Charm is not a word that anyone had been willing to apply to the patient. Many said he was a freak, an antisocial weirdo, but never charming. His social problems often appeared to inadvertent blunders rather than purposeful attempts to insult or confuse others. Psychopaths are self-aware and able to regulate and tailor their behaviour. Clearly, this patient didn't possess any such abilities."

"It was his mother who confirmed my growing concerns about the diagnostic incorrectness of a personality disorder. She disclosed that these were not the first instances that teaching staff had made a note of the students' problematic social conduct, and that she didn't find it surprising at all that his career as a law student had been fraught with difficulty right from the start. The patient's first lie was exposed when she gave confirmation that the problems had been there all through his childhood. She was able to provide a lifelong psychiatric history. Somatically healthy, the patient comes from an intact core family of two children with parents in academia and business. The mother explained that the patient had delayed development in terms of verbal engagement with others, that he engaged in stereotypic behaviour as early as in infancy, and that there was little evidence of symbolic or imaginative play before the age of three."

Sherlock's stomach churns, and he wants to cover his ears with his palms. But he has to sit still, no matter what his body wants to do.

"She said he had severe difficulty in interpersonal relationships from the outset. Symptoms for which his parents sought expert help in early childhood included selective mutism, disinterest in the company of other people, stereotypical behaviour such as stimming, intense interests incomprehensible to others such as collecting dead animals," Wilkes gives a grin at this point, adding, "Thankfully, no pyromania, and I spared the patient's blushes by not discussing bed-wetting." This brings forth a chuckle from the audience; they all are familiar with the Macdonald triad associated with serial killers, now thought to be outdated.

After lapping up the delight of his peers, Wilkes sobers up and continues. "He was taken out of school for being disruptive, home-schooled until his behaviour reached acceptable standards. Now, we come to the confirmation of my suspicions: the diagnosis he received in childhood — keep in mind that he fervently denied ever even having been assessed for anything — was _autism_ , the developmental disorder in 299 in DSM-IV."

Wilkes puts up another slide, one which Sherlock is all too familiar with — the pertinent diagnostic criteria.

Wilkes strikes a triumphant smile. "The symptoms fit, and they fit _perfectly_." Wilkes holds up a finger. "Firstly, as an adult, his failure to relate to the thinking and emotions of others, easily summarised as lack of empathy. That can be easily mistaken for a deliberate desire to hurt and insult others." A second finger comes up. "Demonstrably socially inept behaviour and an associated lack of interest in seeking the company of others". He then holds up the rest of his fingers on both hands, one by one, as he recites: "Communication deficits, odd body language, lack of eye contact, fidgeting — or, as it is often called in the context of autism, _stimming_ — obsessive fixation on his particular interest to the exclusion of the rest of the course material, lack of social reciprocity, being oblivious to other people's feelings or emotions and severe difficulties in interpreting non-verbal communication and sarcasm." He takes a pause to let this sink in. "The more the discussion with the parent went on, the more obvious it became that these criteria applied even in adulthood." Wilkes holds up both hands, waving them in front of the class likes a comedian. "A full house of symptoms, straight out of the textbook. After all, we all know that autism is a congenital defect and incurable."

He returns to his note cards. "The patient's educational history was fascinating. Undoubtedly highly intelligent, that did not help him to cope with others, which is why he was home-schooled. Eventually, he was able to return to normal education and was enrolled in a boarding school until the end of sixth form. Unfortunately, his anxiety problems led to self-medication attempts, for which you should read narcotics abuse. The last time he'd had a breakdown, he'd run away from home, become a drug user, and had to endure a stint in rehab — none of which had been disclosed to the university."

Sebastian pauses, looks up from his cards and nods to the audience. "Well, we know what he meant by 'gap year', now. Not exactly partying on a beach in Ibiza or backpacking through Europe, was he?"

There are sniggers of laughter amongst the students.

Sherlock tries to breathe, so furious he nearly sees spots in front of his eyes. He hadn't had a _breakdown_ ; he just wanted to get away from home! Of _course,_ his mother would have described it as such because she'd never understood why he'd wanted to leave and not be micromanaged by her for the rest of his life!

Wilkes takes up the story again. "The family were able to help him with rehabilitation, and eventually, he enrolled at Cambridge in a field which, according to his mother, practically everyone who knew him considered utterly unsuitable because of his particular difficulties, none of which he was prepared to admit to a counsellor when his behaviour demonstrated just how unfit he was for life as a lawyer. Complete lack of self-awareness; sadly, many psychiatric patients suffer from this. No wonder the Director of Studies was concerned enough to refer him for counselling. This is a patient who has a history of failing to acknowledge, let alone deal with, the anxieties that arise from this developmental disorder."

"It was his mother, not I, who raised a most pertinent question: if the wheels come off again, surely this is a train wreck about to happen? Will he be the only victim, or could he — inadvertently, due to his lack of self-awareness — hurt others, because he's lied about his mental health to the university, to his colleagues, to his Director of Studies? What happens if he manages to scrape through and graduate? Will there be clients expecting a qualified lawyer who end up getting something entirely different? Some of these clients and their family members may be in a fragile state after difficult life experiences. Do we really want them exposed to the likes of this student?"

Sherlock feels poleaxed. Put in those bald terms, Wilkes is accusing him of being a fraud and a liar, as well as being incompetent as a medical student. He can hardly watch as the next slide comes up: a tick-box approach to a summary marking which of the autism diagnostic criteria apply to him. As painful as it is to see it in black and white up there on the screen, it isn't anything new to Sherlock; he'd heard it often enough from the various therapists his mother had forced him to see.

Wilkes isn't off his soapbox just yet. "What is worse is that the patient must have lied about all this on his application form, or at least during his compulsory medical exam with the college's GP surgery. His disability and total lack of suitability for the course should have disqualified him from being offered a place. It's probably the reason why he kept it quiet; that's the part that had made me think of him as having a personality disorder where lying and self-interest are the core of the diagnosis. Perhaps with further examination, co-morbidity might even be diagnosed, even though I'd say autism will still remain the most pressing issue."

Sherlock barely keeps himself from flinching. If he dares to protest, Wilkes would only have to tell the others why he would present such criticism to lay bare his history for all to hear, using his mother's ammunition to discredit him and open him up to charges of academic misconduct and lying on his admission application. Wilkes would get in trouble, but he'd take Sherlock down with him — he's being blackmailed into silence. Medical schools are supposed to be obliged to accommodate disabilities and to make 'reasonable adjustments' for students with… _issues_ , but surely it wouldn't look good at all to disclose such a thing after four years of studies? The difference between what Cambridge is supposed to do in terms of support and inclusivity and what the admissions do in practice is plain to see every time he looks around a classroom. Even those with a visible disability are an incredibly tiny minority of Cambridge students for other courses. Sherlock knows this because he'd looked up the statistics on his entering class — less than three per cent of the undergraduates had declared a disability. Only one of the two hundred and forty-seven undergraduates studying medicine had a declared disability. Is it any wonder why he wouldn't bother? Prejudice and discrimination are forms of institutional bias.

The teacher interrupts, tapping her watch. "A fascinating case, Mister Wilkes, but you need to come to a conclusion to keep within your allotted time."

Beaming one of his supercilious smiles, Wilkes obliging puts up a new slide and gives an apologetic nod to the teacher of this session. "Last one, Doctor Lane, I promise. Herein we have the ethical dilemma, then. I had identified the nature of the problem — non-disclosure by the patient of a mental disorder that would call into serious question his fitness for his future profession, as well as breach of academic regulations about not lying on your application. In the face of this, the question arises, what should I do? Should I inform the patient's Director of Studies of my findings? Or would putting a name on this anonymised case repudiate the doctor-patient confidential relationship? This ethical dilemma is the sort of conundrum that we've often confronted in our clinical placements. Would it harm the patient more to allow him to continue his course, knowing that it will end in disaster — either a breakdown like his previous one, leading to drug abuse, or a catastrophe for one of his future clients? Or do I keep quiet about it, respecting his privacy and giving him the benefit of the doubt? Is not prevention better than cure, if the safety of others is also something that needs to be considered?"

Theatrically, he gathers his notecards and switches off the projector. "I'd be most interested in hearing your views in the class discussion."

This is something that hadn't occurred to Sherlock: he'd been unprepared enough to hear these things from Wilkes, but having to listen to their fellow students echoing his assessment and unwittingly declaring Sherlock unfit and disingenuous…

 _No. I can't do this_.

He is out of his seat and nearly through the door before the teacher has a chance to react. "Mister Holmes? Where are you going? Class isn't over yet."

All Sherlock can manage is a mumbled "Not feeling well; need to leave," before he bolts the rest of the way out.


	13. Disclosure

Sherlock's hands are shaking, and the key skitters across the lock of the plain brown door between the Maharani Indian takeaway and the Golden Buddha restaurant. His heart is pounding from his brisk cycling pace — brought on by a constant sense that something is after him, which he knows to be false but cannot shake — and the fact that his brain cells are swimming in nicotine.

He'd moved into this flat a week ago when the Keynes Building began to empty of undergraduates as they finished their last assignments of the year and sat their exams. He'd had it all planned; staying up at Cambridge and doing a summer internship which would bolster his research CV and give him an excuse to avoid going back to Sussex. The internship was to end mid-July, which would allow him time to prepare for his final year rotations, getting on top of the material without the distractions of his mother dictating to him how he should be spending his day. He'd be living out of college in his own flat, independent and free to focus without the distractions of other students, a chance _finally_ to be who he is when he is alone.

_Best laid plans…_

The whole thing has been hideously derailed by the Psychiatry and Mental Health unit. Ever since the presentation of their portfolio cases, Sherlock has been functioning in a daze. Wilkes' outrageous fabrication of a case based around what he'd pieced together about Sherlock's past has burned a hole in his ability to organise himself, to stick to the daily routines of self-care he'd constructed. _Executive dysfunction_ — it had been up there on the autism diagnostic criteria slide that Wilkes had shown.

He's certainly ticking that box right now. When he should have been studying for his course exams, his brain has been trapped in an endless loop of ruminative thoughts, going round and round, repeating every sneering comment and snide look from Sebastian Wilkes. It's worse than a haunting: Sherlock finds that even when he can finally drop off to sleep, the nightmares take hold, with everyone in the class standing up, turning around and pointing at him, chanting in a chorus, "It's _YOU!_ "

Exhausted and ill-prepared, Sherlock had struggled through the fourth year General Medicine theory exam on Monday, running uncharacteristically out of time on the Cardiology & Infectious Diseases sections. The practicals had been even more diabolic. The mini-clinical evaluation exercises had been challenging to say the least, and he'd completely misunderstood one of the problems set about epidemiology because he'd been too slow at processing the instructions of the clinician setting the exercise.

Today's Psych & Mental Health exam day has been the final straw in what has been a ghastly three weeks. He'd taken twice as long as he should have on the first of the written exam questions, losing all train of thought, having to strike through whole paragraphs and start again. It meant less time on his answers for the rest of the paper's questions, and he can hardly remember what rubbish he had written in his haste. His hands had sweated so much he'd smudged pencil all over the pages.

On the P&MH OSCEs, it has been even worse as he moved through the six stations which tested his practical skills at taking a patient's history, running a differential diagnosis, explaining a treatment plan to a patient, and the like. The unit's emphasis on communication skills ended up with him so tongue-tied and self-conscious on the oral communication of a bipolar diagnosis that the examiner stopped the exercise to ask him if he was unwell. The man told him that if Sherlock could get a doctor's note, he might be able to get a deferral and a re-sit rather than failing. Somehow, he'd managed to shake his head and soldier on so that at least he'd complete the six exercises. As soon as the allotted time was up on the final one, Sherlock had fled the exam room at speed.

He doesn't remember much about the bicycle ride to the flat. Once he negotiated the two roundabouts between the Fulbourn Hospital and Cherry Hinton road, the mile and half had passed in a total blur. He'd tried to open the door, turning the handle twice without success before remembering it had locked behind him when he'd left this morning.

It takes Sherlock three tries before he can get the key into the lock. Once he's in, he shoulders the bike, staggering up the stairs with it and into the flat. The bike gets shoved against the wall before he rushes into the tiny loo, where he drops to his knees and vomits into the toilet bowl. When there is nothing left except dry heaves, he slowly gets to his feet, fighting against the dizziness that blurs and then tunnels his vision. Dully, his brain defines it as _presyncope_ — feeling faint due to reduced flow of oxygenated blood to the brain, without loss of consciousness. It's as if his body is telling him something. Why bother sending blood to such a defective organ? The rest of the symptoms follow in short-order, like some damned practical demonstration of the medical textbook entry. Light-headedness, a sense of vertigo, pounding headache. He's sweating and he can feel his heart beating irregularly. Vomiting has not reduced his nausea; his bowels ache. Gastrointestinal distress has always been a side effect of stress for him, and for the past three weeks, it has heaped on the misery.

There is little to bring up besides bile, since eating has been impossible for the past few days. Sherlock leaves the loo, holding onto the wall to keep his balance as he stumbles back into the living room to crumple down onto the sofa. His sense of proprioception is shot to hell; it's a wonder he didn't fall off the bike and injure himself. Dully, his brain is still in exam mode and supplies another theoretical answer: _malfunctioning mechanosensory neurons located within muscles, tendons and joints_. In his current state, his body is not communicating with his brain, or what little is left of it. He wonders if this is the start of a meltdown; he hasn't had one of those in years, and the idea of it happening now is the final straw. Kneeling on the floor beside his bed, he pushes his head down between his knees to get some blood flowing back in there, and yanks hard on a handful of hair, hoping the pain will ground him, or at least stop the flood of tears running down his face.  
  


__________________________  
  
  


When he feels able to open his eyes again, its dark outside. At some point, he'd slumped down to lie on the floor, and now he's getting cold. Though the window is closed, he can smell the aromas of the Indian takeaway at war with the lemongrass and Thai spices from the Buddha restaurant. Both make him nauseated. To fight it off, he goes to the tiny gallery kitchen and runs the cold tap, filling a glass. He knows he needs to keep hydrated. At least the dizziness seems to have passed.

Lighting a cigarette, he can hear his mother's voice. ' _How is that going to help you, William? You're the one who wants to be a doctor; surely you know the health consequences of smoking!_ ' He ignores the voice, knowing that if he told her how he feels, she'd be even more scandalised and would lecture at him how it's all his own doing.

He hasn't felt a craving like this for years. It feels as though the marrow in his bones is throbbing, as though his blood is churning in his veins and the thought of a bright pain of a prick of a needle is like a beacon in the darkness. It is yet one more sign of how everything is coming apart at the seams. If he can't keep his neurotransmitters happy with nicotine, then the alternative is calling to him, telling him to go for a more effective way to stop the reabsorption of dopamine — by injecting cocaine. Ever since he'd been through rehab five years ago, his determination against relapsing has always been because it is necessary to stay clean if he wants to go to medical school, graduate and become a neurosurgeon. With that dream retreating, he wonders how long he will be able to resist the temptation.

_Retreating? Or gone for good?_

Sherlock knows he is almost certain to have failed the psychiatry OSCE at the very least. Maybe he will have passed — albeit only barely — Monday's general practice and family medicine exams. Apart from the Cardiology and Infectious Diseases sections, it had seemed simple enough and his course assessments had been good until the exam. He's lost all sense of how to judge his performance relative to his peers and is quite simply terrified that today's debacle has just ensured the end of his medical school dreams. The only tiny shred of hope left is that he doesn't yet know what marks he will get on his three cases portfolio and the written assessments of the clinicians who oversaw his mental health module placements.

He draws the smoke deep into his lungs, feeling the rush. The nicotine kicks in soon enough and lends him enough energy start pacing in the small living room. If — no, _when_ — he is told that he's failed the psychiatry course, the question is whether he will be allowed to take it again. After the resit and remedial practical work he'd needed in the gynaecology & obstetrics unit last term, another failure is almost certain to put an end to his aspirations for neurosurgery. Only the best and the brightest get in; it's the most fiercely competitive of all the surgical disciplines. Re-sitting parts of not just one but two courses is enough to get him dropped from the list for elective neurosurgery specialism in his final year, and lacking such a rotation would be a red flag when he applied into neurosurgical training proper. If he can't fulfil that dream, is it even worth staying in medical school? None of the other courses he's taken so far appeal to him in the same way. Will he be allowed to stay in surgery? If the other exams went badly, then even that could be off the agenda. It would be unlikely that any other surgical field would take him in, and conservative fields don't interest him. _All they do is dispense pills. They can't go in and fix the problem like surgeons do._

Wilkes will be so delighted to learn that he's been relegated. It would mean that the bastard would get revenge twofold. Presenting that case was just the trigger needed to ignite a powder keg under Sherlock's confidence. His dreams have gone up in a bonfire, fuelled by every self-doubt that his ever had. Being shown in such blatant fashion how unfit others would consider Sherlock for a medical career if they knew the truth has proved to be his undoing. The whole portfolio case concocted by Wilkes was the most outrageous fabrication, the most egregious example of academic misconduct that Sherlock could ever imagine. And yet Wilkes believes he will get away with it, because if Sherlock were to expose the fraud, it would mean he'd have to expose his…his…

The word sticks in his mind like a knife _: disability._

It doesn't matter that he hadn't been named in that presentation. _Irrelevant._ His defects had still been laid bare for all too see. To file a complaint against Wilkes would mean he'd have to admit to being the template on which the case was built. Every line would be scrutinised, and he'd have to confess what was truth and what fabrication. He'd have to admit the fact that he'd not declared his disability at the outset when he'd applied and when he'd begun his studies. Sherlock knows that the equal opportunities law says nice, saccharine things about privacy and individual rights, but he is also aware that informal discrimination is still evident. He'd not _lied_ outright on the application forms, but would it be seen just as bad to have lied by omission?

He stubs out the end of the cigarette and immediately lights another. Pacing again, he recalls vividly the echoes of the sneer of superiority in Wilke's presentation. Stigma against medical professionals with a disability is real, and it had dripped from every venomous word the idiot had uttered during his presentation. Even those who should know better are well capable of prejudice and wrongful assumptions.

______________________  
  
  


It takes him four more days. Four days without significant sleep, without food. Copious amounts of coffee and tea are consumed, and he has to go to the minimart across the road daily for more cigarettes. He's still wearing the same clothes he wore for the exams, but the smell of his poor hygiene is masked by cigarette smoke.

He's a mess, but finally…

Finally, he's _angry_.

 _It wasn't supposed to be like this._ Wilkes's cruel abuse of his knowledge in order to cheat on his portfolio assignment shouldn't be allowed to prevail. It's outrageous. If, as is likely, Sherlock's failure in the course demolishes his chances of being a neurosurgeon and slaughters his motivation for the entire profession, then the least he can do is make sure that such a malignant bully doesn't win. If he can't graduate from medical school and pursue the career he wants, then why the hell should Wilkes? _Why should this monstrosity be rewarded?_

Sherlock has dealt with bullies all his life. He's always been belittled, micromanaged and nagged by his mother his whole life: ' _don't do that, William; why can't you do what I've told you?_ ' was perhaps the phrase he'd heard the most from her. Outside of home, if it wasn't the village kids in North Chailey, then it was schoolmates. Once away from the relative safe cocoon of home-schooling, he'd learned the hard way that acquiescence is surrender, and that surrender only makes bullying worse. If he admits defeat and doesn't bring Wilkes down with him, then he's not just letting himself down, he's rewarding a man who will go on to mistreat others.

Sherlock knows his family will seize upon his failures as final, conclusive evidence that he's unsuited to the medical field. His mother will go on and on, and on about how she had told him so, and has now been proved right. He has to fight back, if only to preserve some tiny shred of self-respect.

 _Enough_.

He puts the cigarette down and picks up the receiver of the phone on the small desk, stabbing in the number he'd written down on the back of his hand last night.

After three rings, a female voice answers, "Hello, Student Counselling Service. How may I help?"  
  


______________________  
  
  


It takes him another week of talking to the SCS, formulating comprehensive documentation and perusing the Faculty of Law libraries before he's ready. He's forced himself to eat enough to get by but has only slept in tiny increments. His internship is due to start next week, but he's not spent any time preparing for it. Instead, he's focused on preparing his case against Wilkes. In the short space of thatweek, he has become something of an expert not just in laws governing disability but also in the rules and regulations that almost every Cambridge student can't be bothered to read before signing the form at matriculation.

Ironically — after hearing that their name has been dragged into the proceedings through Wilkes' impersonation — the Student Counselling Service has been the most help. At their suggestion, Sherlock has made an appointment to meet his Director of Studies at Kings, Doctor Benington. On the Student Counsellor's advice, he's had his hair cut short, his face closely shaved, and he is wearing a jacket and tie. In hindsight, he's embarrassed to realise how completely oblivious he'd been about the deterioration of his daily habits, but then again he'd had more important things to think about.

Hideously uncomfortable but presumably more presentable, Sherlock is now seated against the book-lined walls of Benington's office in Bodley's Court, overlooking the River Cam.

He needs to talk to the professor because, at the very least, he may be able to answer the question that has plagued Sherlock for the past fortnight. _Did Wilkes decide to take his anonymised patient X case to the medical school, to report Sherlock as unfit for medical practice as he had said he was considering during the case presentation?_ It had scared Sherlock witless to discover that, under the Cambridge University Medical Students code of conduct, Wilkes would have the theoretical right to do so. Article 16 is clear: Students are required to ' _seek immediate advice from the Clinical Dean or one of the Clinical SubDeans if you think a doctor or colleague has behaved in a way that suggests that he or she may not be fit to practise'._ If Wilkes has done it, by now the news of it will have reached King's Director of Studies for the college's medical students.

Ironically, this is also the main clause that drives Sherlock's own case against Wilkes. The code gives some examples of behaviour that would disqualify, including ' _misusing information about patients, treating patients without properly obtaining their consent, behaving dishonestly in financial matters, or in dealing with patients, or research…_ ' The SSC administrator warned Sherlock that there may be a problem in that he was not a 'patient' and that it may be necessary also to invoke University regulations about students' treatment of each other. _Semantics and technicalities_.

Sherlock had pointed out to the administrator that article 8 required medical students to ' _be open and honest: do not break the law in any way, never threaten violence, act violently towards others or act dishonestly. Do not engage in bullying and harassment of fellow students or professional colleagues'._ Wilkes' abuse of personal information, his impersonation of a doctor in order to obtain confidential information from his mother, without his consent, was a breach of civil law, let alone the university's codes of conduct.

 _'You'll have to prove it, or it's your word against his,'_ the administrator had advised. _'While the complaint procedure uses a balance of probabilities standard rather than legal proofs, any action by the University has to be evidence-based because if there are repercussion for Mr Wilkes, he is likely to sue.'_

That stark warning has led Sherlock to where he is now, sitting in the office of his Director of Studies. When Benington appears and takes a seat after a formal greeting, Sherlock pushes across the man's polished desk a five-page paper that outlines every specific element of Wilkes' breach of confidence, his misuse of Sherlock's personal data and the facts of his impersonation of a university counsellor in the phone call to his mother.

Doctor Benington scans the pages whilst listening to his statement, with ever increasing signs of amazement. _Or is it disbelief?_ Sherlock has always struggled to grasp the difference in terms of facial expressions.

When Sherlock is finished with the summary of his formal complaint against Wilkes, the Director of Studies tosses the papers on his desk, leans back in his chair with a frown. "This is the most extraordinary case I've ever heard in my twenty-three years as an academic." He shakes his head. "Plagiarism? — a dime a dozen, as our American colleagues would say. I've heard complaints about sexual misconduct, drug and alcohol abuse, fabrication of research data… but nothing like this story."

Willing his hands to remain still, Sherlock asks his first question. "To your knowledge, has Wilkes brought a complaint against me?"

Looking confounded still, Benington shakes his head slowly. "Not that I know of. He'd be mad to do so because if you say he's fabricated this evidence and obtained information under false pretences, then he'd be opening himself up to charges of academic misconduct."

Sherlock breathes a sigh of relief. He'd hope that this would be the answer, but his whole sense of what is possible in this situation has been badly shaken. Wilkes might have been enough of a nutcase to have carried out the threat he'd implied at the end of his presentation but hearing Benington's denial shows that it had just been yet another attempt to twist his knife into Sherlock.

Benington is studying him with his gaze. "What I don't understand is _why?_ Why would a fellow student, someone you worked with as your clinical pair, do such a thing? It beggars belief. I mean, surely he would know that you'd turn him in?"

Now, it's Sherlock's turn to shake his head in denial. "I'm sure he assumed that I would not seek action because it would mean disclosing the facts behind his differential diagnosis of Patient X, in which he concluded that the subject was unfit for medical school and the profession itself. He banked on me keeping quiet, lest others become aware of this personal information."

"That's as good as blackmail," Benington points out.

Sherlock bites his lip and nods.

"…if it's true," the professor adds.

Sherlock grips the arms of his chair tightly. "It is."

"Are you absolutely sure? I mean, it could be that Wilkes did interact with a law student who is autistic and had gone to the Student Counselling Service."

Sherlock draws a deep breath, then leans closer and pushes the papers closer to Benington. "Read that paper, sir, _properly_. It's all there. Wilkes phoned my mother, and the details of that call were relayed to me by her. If you call her, she will tell you the same."

Sherlock has not been in contact with his parents since that dreadful call, but he doubts she would deny any of it when asked. Why would she? As far as she's concerned, Sherlock's diagnosis coming to the attention of the faculty is a _good_ thing.

Sherlock forces himself to make eye contact with Benington. "Sebastian Wilkes used verbatim quotes from our practical seminar questionnaire exercise and made up the rest. This is all blatant abuse of my personal information, misused as a fabricated case study. The fact that it is modified in part doesn’t mean it isn't false. _None_ of that information was obtained by consent. That alone is a breach of academic rules on the assignment. What is more, the Medical Act of 1983 states that ' _Any person who wilfully and falsely pretends to be or uses the name or title of physician, doctor of medicine, licentiate in medicine and surgery, bachelor of medicine, surgeon, general practitioner or apothecary, or any name, title, addition or description implying that he is registered under any provision of this Act, or that he is recognised by law as a physician or surgeon or licentiate in medicine and surgery or a practitioner in medicine or an apothecary, shall be liable on summary conviction to a fine not exceeding level 5 on the standard scale_ _'._

Drawing a nervous, shuddery breath after rattling all of that off at breaknack speed, Sherlock looks out the window rather than at his Director of Studies. He then says firmly, "I won't be bullied into keeping quiet, even if it is to my own detriment."

"How so?" The academic seems puzzled.

Sherlock shrugs. "Once you take this complaint forward, I will have to admit to the parts of the case that are based on me. That I am… autistic, something I have not disclosed to the university and would prefer to keep private. I will bear the consequences of not disclosing that fact as long as Sebastian Wilkes bears the consequences of what he's done."

At this declaration, Benington leans back in his chair again, folding his hands in his lap. "Playing devil's advocate here: if you prove that Wilkes made it all up, misusing your personal data without consent, then he's likely to fail the assessment. That's one assessment, which may or may not result in him failing the unit. Are you sure you want to proceed, if it's going to involve you in revealing things that you'd rather keep private?"

Through clenched teeth, Sherlock snaps, " _YES!_ I intend to pursue the complaint. I'd rather this was done in the context of the medical school's code of conduct than through the police. This is also a breach of university ordinances. Clause 6 of Chapter Three says that no member — that includes a student — ' _shall engage in the harassment of another member, and goes onto define that as unwanted and unwarranted conduct which is reasonably likely to have the effect of violating that person's dignity or creating an intimidating, hostile, degrading, humiliating or offensive environment for that other'_. According to the Rules of Behaviour for Registered Students, a student must not ' _forge, falsify or improperly use information to gain or attempt to gain an academic or personal advantage'_. That's also in the university regulations."

Benington's eyebrows rise at Sherlock's quote from the regulations. "You are remarkably well informed."

"He's given me no choice."

"Well, as I said before, this is an extraordinary situation. Unfortunately I must also tell you, Mister Holmes, this is not a matter for me. You need to report this to OSCCA, the Office of Student Conduct, Complaints & Appeals. They will appoint a Student Discipline Officer, who is trained in managing this sort of thing. An investigation is likely to be launched to determine whether this SDO thinks that the offence is minor, in which case, he or she can impose a minor sanction on Mister Wilkes. If the view is that it's major, then the SDO refers it to University's Discipline Committee. They consider the case, decide whether to dismiss it, impose a minor sanction or the ultimate sanction — expulsion. If you don't like what they decide, you have the right of appeal. I should warn you that all this will take time, especially as the academic year is coming to a close. In a month's time, a lot of the staff involved in these processes will be on summer leave. So, it could take until the end of August before there's a decision."

______________________  
  
  


Sherlock is so furious at Benington's refusal to do anything more than to tell him to go elsewhere with his complaint, that he does exactly that. Riding his bike straight from Kings to the Student Services Centre on Bene't Street, Sherlock completes the required OSCCA form and hands over the file with all of its supporting evidence.

When Sherlock is back at the flat, lying on his bed, staring at the ceiling, the thought occurs to him that he is officially in limbo. It could be months before a decision is made, during which time he will not know whether Wilkes would get away with it. What makes matters worse is that he also has to wait for his exam results, which are at least seven weeks away. Even if he managed the miracle of passing, then he's got to sit and wait for the OSCAA decision that could potentially terminate his medical studies if they decide that Wilkes' motives overrule his methods and that Sherlock is the one at fault.

His internship is due to start soon. It's going to mean the outstanding stress of dealing with new people, adapting to a new environment, and for what? As a swan song to his medical career? Even just the thought of going to the grocery store feels crushingly difficult right now. This term has drained his reserves to an extent he wouldn't have expected, and even if Wilkes gets his due, where does that leave Sherlock?

_Maybe there will be no end to this, just the next Wilkes. And the one after that. And everyone else secretly agreeing with them though they're too afraid to tell that to my face._

How can he be expected to function with this sword hanging over his head? If the past three weeks have been hell, what is going to happen when he has to wait for ages for any sign of the direction his life will take from here?


	14. Complications

"We'd like you to attend an assessment," Professor Benington tells Sherlock.

"Why? What kind of an assessment?" Sherlock demands, cursing himself for answering the phone.

It's been two days since he'd seen his Director of Studies and has not heard back from OSCAA. Could it be that Benington getting in touch again means that he's stirred up enough trouble with his complaint that the faculty is now interested not just in Wilkes but him as well? He suspects this may be them trying to sweep all problems under the rug, to wash their hands of all trouble before disappearing off to some research engagement abroad. _That's what they all do during the summer._ Sherlock knows that Directors of Studies are supposed to provide pastoral care or whatever nonsense it's called, to pry into students' private lives. It's all well and good for those with no skeletons in their closet, but Sherlock wants to keep such busybodies out of his life. He'd been mortified by their meeting; if the man was so uncaring and dismissive of what Wilkes had done, why can't he just let Sherlock be, let him wait it out until the OSCAA investigation is over?

"The Disability Resource Centre has an excellent neuropsychologist who has worked with medical students before," Benington explains.

"No. Absolutely not. And I won't discuss this again." The very thought of being forced into some assessment by his Director of Studies is horrid. _It's almost as if the man is trying to turn Wilkes' fictional account of his Patient X into reality!_

"You told me you've spoken to the Student Counselling Service."

"I talked to them because Wilkes _used_ _them_ , but that was only to make some general enquiries which confirmed my interpretations of disability law and university rules. I didn't speak to them because I wanted some sort of _psychological_ _help_." He forces these two words out through clenched teeth.

"I know you must be eager to put this unfortunate business with Sebastian Wilkes behind you, but there may be a silver lining here, Sherlock."

"I can't possibly tell what that could be."

"I know you told me that you had not wanted to disclose your diagnosis; I am only thinking of your best when I suggest that you should at least have this assessment, to talk to the Centre staff about what they could offer."

"Is this a thinly veiled threat? Are you trying to stop me from making my complaint about Wilkes? It won't work; I've already filed it with OSCAA."

"No, of course it's not a threat; I know about the complaint because OSCAA has to inform the Dean of Studies and me about these things." Benington sounds a bit put off, now.

"Then, if it isn't a threat, precisely, it could be an order disguised as a recommendation? If I don't do this, then what?"

"You know that some teachers have raised the issue before about your patient communication and teamwork skills."

"Or lack thereof, according to them." It irritates Sherlock that Benington is willing to raise the issue but not be frank about it. This is what it would be like if he made some stupid, useless, embarrassing disclosure: teaching staff would get awkward about him, and instead of helping, they would give more reason for his course mates to shun and ridicule him.

 _I won't be labelled as some special needs student ever again_.

"Some of your practical rotation evaluations this term––"

"I'm well aware of what's happened this term. _I was there_."

"There's no need to get defensive, Sherlock. Your course evaluations and the OSCAA investigation are two separate matters, and one does not make the other redundant. My duty is to help you, and what we are suggesting is not a diagnostic assessment but a functional one."

"Who's _we_?" Sherlock asks venomously. This is precisely how his mother used to phrase things, to make it sound like it was everyone else against Sherlock. _'This is how everyone else does this, so you have to learn to do it that way.'_

"The Dean and I, and I've spoken to the Psychiatry Course Leader who thinks this is a very good idea."

"Well, I don't. And saying something is functional rather than diagnostic is just semantics."

"The neuropsychologist would look at life skill areas important to student life and the medical profession. Surely you see the benefit in that."

_What benefit? Surely, they're just looking for evidence that I'm not fit to be a doctor?_

Perhaps Benington reads something in his silence because he continues. "You have come this far, Sherlock, and excelled at the academic side of your studies. It doesn't seem likely that any major red flags would be raised by this evaluation."

"Then why make me do it at all?"

"We cannot _make_ you do it, Sherlock. But we are concerned about you and can appeal to your sense of responsibility. What would you advise a patient in your situation?"

 _This is manipulation, and Benington knows it._ Anger rises in Sherlock. "I would tell them to make the decision on their own because only they can know what's best for them."

"You have just undergone the psychiatry course, Sherlock. Do patients always know what's best for them?"

The insinuation is as plain as day: Benington now sees him as someone with a mental health issue. "I'm not psychotic or classed as a vulnerable adult!"

"Of course not, but perhaps this is such a difficult matter for you that you're not the most objective person in evaluating whether getting some extra support for your studies would be a good or a bad idea. And there is another reason, too, one relevant to your accusations about Wilkes, though I must stress that the evaluation will in no way be a part of the OSCAA process."

"So, in what way is it relevant, then?"

"Now that he knows you have filed the complaint, he might try to argue that you are the one who is unfit, and he was only doing what he thought was right. If you have a functional assessment that shows you are competent, then your charges of harassment and bullying are more likely to succeed."

 _I have to do this_ , Sherlock realises. _I have to do this to prove them wrong, so they'll leave me alone_. He can misdirect. He can obfuscate. He can deduce what this psychologist wants to hear, can't he? "I still won't make an official disclosure."

"You don't have to make that decision now. We can return to that after the assessment."

"And who's going to see the results?"

"Only the Dean of studies and I, for now, with your permission."

 _'For now'. It's a permission you are effectively blackmailing me into giving._ "No one else. Not my mother, not other staff, not some GP, _no one_. Especially not Wilkes, no matter what kind of a counter-complaint he makes," he adds for good measure.

"Of course not."

He shifts the receiver to his other hand; his palms are sweaty, and his heart is pounding against his ribs.

"And not a word to anyone at my summer internship."

"Agreed. Your appointment is tomorrow."

 _Tomorrow?!_ "How the hell did you make it without my approval?"

"I spoke to the neuropsychologist without mentioning a name. I had to make a special request because they are a bit overwhelmed at the moment dealing with students trying to get assignment deferrals confirmed based on medical issues. They've pencilled you in; all you need to do is phone to confirm."

Sherlock ends the call without saying goodbye and only realises it afterwards. The notion of that appointment has engulfed him in a deluge of anxiety which had derailed his usual social scripts.

He'll have to be on his best game if his medical career is going to survive this.

______________

He does his homework. After confirming the appointment, he spends the rest of the day researching and re-reviewing the university's rules and policies about disability and discovers that, in order to attend an evaluation appointment, he has to make at least a restricted disclosure but that only involves the Centre. Only a Full Disclosure would allow them to discuss things with the College or Medical school staff. Sherlock has now practically memorised the Disability Discrimination Act and other associated legislation; the trouble is that the aim of those laws seems to be to guarantee individuals are given the support and assistance that they want and need. Protecting those who want nothing to do with any kind of disability support systems has not been a priority.

It appears that Benington had — either deliberately or due to ignorance — slightly misrepresented these facts. He and the Dean will want to see the results, but they won't automatically receive them without Sherlock's permission. If he doesn't make a Full Disclosure, only he can pass on those results. This means that at least some control remains with him. If the results are… unacceptable, then he'll withhold them and involve a solicitor, if need be, to ensure they can't hold him back from continuing his studies.

 _That's assuming I do pass the psychiatry course_. The more he has thought about his answers on the theory exam, the more he'd realised it probably wasn't quite as bad as he'd feared; with luck, he'd pass that. The OCSC practicals, however, are anyone's guess, and there are also the practical assessments all of his and Wilkes' clinical rotation supervisors will submit. Those might still sink his chances.  
  


______________

Jeannette Hallam is the neuropsychologist to whom Sherlock is assigned for his assessment. She turns out to be a no-nonsense individual in her late forties. Not much for smiling, she gets right to the point by inquiring about his diagnoses, his family and his school history. Sherlock provides a concise, economical version of the truth, working hard to ensure that Hallam doesn't become interested in knowing more about his mother — or God forbid, contacting her. _She's done enough damage for now, including through Wilkes._

"Your Director of Studies told us that what you are looking for is a functional assessment in order to identify and address key areas for improvement, particularly in terms of interpersonal communication."

 _I'm not looking for a damned thing._ "Improvement? How?"

"That will be evaluated after the assessment. I cannot make a recommendation before knowing what those challenging areas are."

 _Can't operate without all the data_. Sherlock can accept this premise. At least it doesn't sound like Benington has put too many ideas in her head about what is supposedly wrong or lacking about him.

On the phone, she had asked him to deliver copies of verbal course assessments from his studies. He had selected a few of the more positive ones.

"I think we can move quite swiftly past cognitive performance level and IQ; clearly, being admitted to the medical programme and your research activities prove there is nothing lacking in that regard," Hallam states plainly. "You have done well in written examinations."

Sherlock studies his hands which he has arranged onto his lap. He'd dragged his chair close enough to the psychologist's desk that he can fidget without her noticing: flick his fingertips with his thumbnail, touch his fingertips with his thumb one by one, and make fists when he feels particularly tense. Forcing himself to make frequent eye contact is disconcerting and tiring, but this needs to be the best performance he gives, and the length of the appointment — and hour and a half — will be a test to destruction to what he'd learned as a child about blending in, about not attracting attention, about emulating a _normal_ person.

He swallows, shoves his palms under his thighs. _Quiet hands_.

"Would you say you get on with your fellow students?" Hallam asks.

"They choose not to get along with me. I don't seek out their company. Mostly, I just wish for them to leave me be."

"Would you like more of their company?"

"No."

"And why is that?"

"They don't share my interests, and I find many of them quite childish and irresponsible about their studies. I'm not here to waste time partying like many of them seem to be."

"How do you spend your free time?"

"I study. I have participated in some research. I read."

"Team sports or student clubs?"

"No."

"Do you have friends outside of medical school?"

"No."

"Why do you believe other students don't seek or enjoy your company?"

"As I said: I'm here to study. I don't bother to pretend to enjoy the things they do: drinking, spending time at bars and clubs, indulging in pointless activities like watching sports. They don't like my honesty and my lack of social conformity — they see it as a threat. I can't deduce what is expected of me in social situations, at least not quickly enough to respond in an appropriate manner. I suspect it makes me come off as humourless and slow."

"What about teaching staff? How have you got on with them?"

"Fine. They value students who prioritise studying, and they seem more tolerable of subpar social performance so long as it is compensated by above-average academic performance."

"What is your support network like?"

"I don't know what that is supposed to mean."

"Do your parents support your medical studies?"

"They are paying for what isn't covered by my grants, yes."

"Do you think those things are synonymous, paying and being supportive?"

Sherlock shrugs. He doesn't want to discuss his parents. _I need to avoid any red flags about lacking support systems and other such nonsense. I don't need family support or other such nonsense because I can't afford to need them for anything. I'm all I've got, and it needs to be enough._

Once, he'd had Victor, and all that had ended with was a world of hurt. _Never again. Alone protects me._

"How do you find teamwork when it comes to patient care?"

"When there are defined clinical roles instead of some pretentious classroom nonsense enforced on students, it's fine. I don't enjoy _being_ a student; often the things we do with patients don't benefit their care in any meaningful way, and the staff who are not in teaching jobs treat us like nuisances."

"Do you have a problem with authority?"

Sherlock is startled by the question. Hallam doesn't look like she's trying to provoke him. She's simply being honest, perhaps — she has some of Sherlock's assessment slips in front of her which she's eyeing.

"You have, on occasion, contradicted and argued with teaching staff, including at lectures."

"They shouldn't let those people teach who don't even understand what they are trying to explain." An example comes to mind from a lecture on kidney function. The lecturer had explained the functions of the loop of Henle all _wrong_ , and if nobody pointed that out, wouldn't the entire class have learned it incorrectly?

"Do you recognise that there are less confrontational and more diplomatic ways of correcting people, ways that help them preserve face?"

"I'm not an idiot; I simply don't see the point of sugar-coating things. Is it more important to stoke people's egos than it is to ensure that future doctors learn things correctly? I don't have a problem with competency-based seniority, but I don't like power games and being treated unfairly," Sherlock scoffs, crossing his arms.

"Do you feel that you have been treated that way?"

"I was bullied into this appointment."

"You have studied medicine for five years now. Why did you elect not to disclose your disability before now?"

"I don't like the word; I'm not disclosing anything, I don't need any help, and I don't want to give anyone the chance to say I was _helped_ through medical school. That I didn't meet the same standards."

"You don't see it as a disability? Is this why you are reluctant to make even a restricted disclosure of your diagnosis?"

"I refuse to disclose it because I don't want it to impact the way teaching staff treat me. I don't want special concessions. I don't want anyone to say they let me through even though I don't fulfil the criteria other students must measure up to."

"If you disclosed, you would be eligible for additional support in your studies; wouldn't that help you deal with the fact that the autism is a complication for your medical career just as it is one for your medical studies?"

"It doesn't matter what it is or isn't! I don't want it to define me!" Sherlock is glaring daggers at the neuropsychologist. He feels cornered and is ready for a fight since he can't well flee the appointment.

"If it came to either accepting support and assistance or having to withdraw from the College after failing courses, which would you choose?"

"Is that what my options are?" _Would they really tell me if they were?_ The psychiatry course results have not arrived yet. Does Hallam know something he doesn't? "Are you saying I've failed recent courses?"

"It's a hypothetical question. If a gifted individual with a disability could be helped through their studies with some support and without it, they would fail, would their potential not be wasted if they chose the latter?"

"The _hypothetical_ answer is that I wouldn't want to be a part of a profession that wanted me to graduate as _less_ of a doctor than my peers."

"Don't you think that sort of thinking is a bit inflexible? Through additional support, you could be shown to have reached the same educational milestones as others."

Sherlock's mouth thins into an angry line, and he resolutely stays silent.

Hallam purses her lips, jots something down on her pad. "Are you punctual?"

"Very, when I have to be. I have a system." He is never late for lectures or other teaching sessions; he turns his work in on time. He uses notes on his calendar, has three alarm clocks for different purposes. He knows he can easily lose track of time when something catches his attention, so he's had to learn to work around that.

"Do you find it easy to improvise, to change your approach to patients, to tailor your manners to them and different staff personalities?"

"I am not good at predicting what people expect of me in terms of emotional rapport or communication, no." _I have scripts and patterns and drop menus and lexicons in my head of what people often say and what they actually mean and what expressions usually mean._ However, there is absolutely no way he is going to tell her any of this, lest she uses it as a weapon against him.

"Your Director of Studies' referral to us noted that this term, your interactions with your assigned student pair have been confrontational and occasionally disrespectful."

 _And Benington had the audacity to claim that this evaluation wouldn't be relevant to that investigation!_ "That student is currently facing an inquiry into unprofessional conduct against me."

"So, you're saying it was all him? That you never lost your temper, used negative language about him in front of patients?"

"I was provoked. Wilkes and I didn't get along, never have. He chose to indulge in unprofessional, unethical and underhand action that will likely result in his expulsion. Or, at least, I hope it will if this university has any shred of decency in its staff. I don't generally _misbehave in class_."

"It does appear that issues pertaining to impulse control and behavioural control during staff and patient interactions are a recent thing rather than a chronic problem. There is, a remark in the assessment comments you gave me, one from an internal medicine supervisor, who said that the language you used with patients was either too complicated or too blunt. Do you think can be explained by a functional problem related to any communication deficits?"

He tries to stop himself from rolling his eyes at her attempt to tick off another diagnostic box. "Patients expect too much touchy-feely nonsense and don't understand much about their own bodies. I tell them the truth and use my time with them efficiently."

"Is it not the physician's job to explain things to laypersons in an understandable manner?"

"Not every specialism places the same demands on doctors in that regard. In the operating room, I won't be talking to the patients; they'll be anaesthetised. Either they respect my surgical skills and medical judgement, or they don't, in which case they are welcome to seek out another surgeon."

"Your integrity was commented on favourably by Professor Benington."

"That's the first favourable thing anyone's had to say about me this term, then."

Hallam changes the topic again. "Do you know what emotional regulation means?"

Sherlock produces as text-book an answer as he can: "The conscious or non-conscious control of emotion, mood, or affect. It's an active thought process or a commitment to a behaviour to control the expression of emotion."

"In simpler words? As if you were explaining it to an elderly patient.

 _So, she wants the idiots' version_. "Self-restraint?" he offers.

"Yes. It means the ability to contain emotional responses adequately so that emotions don't interfere with one's work. It's also considered to be a coping mechanism. Have you had any difficulties with this in your clinical environments?"

The idiotic clinical skills sessions with the trust exercises come to mind, and the last thing Sherlock wants is to discuss those. "No."

"Two of your supervisors this term have commented positively on your diagnostic skills and knowledge."

"So?" He's secretly pleased.

"It means that decision-making and judgement are not areas we need to delve into any deeper, I shouldn't think. Do you use drugs or alcohol?"

"No. Not at all."

"Other addictive substances?"

"I smoke." _I'll give her that and hope she won't dig any deeper into the past._

Hallam jots down something just as she's been doing throughout the interview. "What about any risky hobbies? Not an adrenaline junkie, I take it?"

"I like skiing, but I wouldn't say that I do anything particularly adventurous with it. I haven't had time to do it in the past three years."

"We have now covered the assessments of your teachers, and on several specific things regarding your ability to execute occupationally relevant mental functions. There is one more area I want to touch on, and that's self-awareness and self-care. They are something Professor Benington said he has concerns about."

"Did he tell you to say that?" _Couldn't the old fool raise the subject with me directly instead of turfing it to some psychologist?_

"No. Why would he have?"

"You just said––" Sherlock exhales and glances at the clock. _How long is this going to take? Is she really going to grill me here for the entire hour and a half?_ He had expected forms to fill, cognitive tests and such, not this interrogation.

"Do you eat regular meals and sleep at least six hours a night?"

"Yes," Sherlock snaps. "I change my clothes, take showers, shave, brush my teeth. I am not a child, Miss Hallam."

_Regardless of what my mother thinks._

"Have you ever had significant trouble with those routines as a result of stress?"

He doesn't answer.

"If you want to be a clinical physician, you can't cherry-pick just those parts of the work which come easier to you. You will have to communicate with other staff, patients and their family members, often about sensitive subjects, and to tailor your communication strategy to different individuals. Do you often have to spend a lot of energy working out how to engage with others?"

"What do you think?" Sherlock snaps. "Doesn't everyone?"

He knows the answer. He knows that other people aren't constantly preoccupied with trying not to embarrass themselves, to fail at being understood and understanding others. He knows that dealing with other people doesn't drain them the way it does him. They _enjoy_ the company of others because they're capable of acceptable humour and spontaneity and communication that reassures and relaxes others.

"Would you ever be willing to accept that your autism does pose very specific and significant challenges for your medical career?" Hallam asks, gaze fixed firmly on him.

Sherlock bites the inside of his lip so hard he draws blood. He opens his mouth, tries to put something, _anything_ together that would be a cuttingly effective dismissal of the entire question, but he draws a blank, mind scrambling to grasp something and finding nothing.

_If I say yes, they have what they need. If I say yes, they will insist that I can't argue against full disclosure. If I say no, they'll hang me for that denial, say I lack self-awareness._

_I'm damned if I do, damned if I don't._

Without sparing another glance at the psychologist, he springs to his feet and marches out, slamming the door so hard it vibrates on its old, creaky hinges.


	15. MIA

"Could you please connect me through to Doctor Willis, please?"

"Please hold the line."

Before she can say it is important that she be put through immediately, Violet hears a click and the sound of a hideous performance of Vivaldi's Four Seasons starts up in her ear.

She had tried hard to keep the concern out of her voice because she is trying not to panic. Her calls to the phone number of her son's flat four times over the last two days have gone unanswered and, no matter what hour of the day or night, it is giving an engaged signal, which is impossible. William _hates_ talking on the phone because it makes it even harder than usual for him to interpret social cues and hold a proper conversation. So, either the phone is off the hook, and he hasn't noticed, or it's out of order.

In either case, she can't get through to him. She's even tried ringing the university hospital, only to be told that they have no way to reach any medical student even if it was term time. "You'll have to contact the college," they told her.

She's done precisely that — only to be told by the porter at King's that he has no contact details for him during the summer, and that William hasn't been in to collect post from the pigeonhole for more than ten days. The rather off-hand response had annoyed her, but at least it explained why her son has not responded to the letter she'd sent him, telling him in no uncertain terms what she'd thought of his idea of staying in Cambridge for the summer to work as a research assistant. _Without the routines of his academic schedule and the constant supervision of the college staff, he will be cast adrift._ William must have anticipated her disapproval because he hadn't provided contact details to his summer employer.

The fact that he's out of touch is hardly unusual, but the big picture forming worries her tremendously. She's spent a lifetime worrying about William, but this is worse, somehow: there is an odd sense of dread making her restless, and she can't quite place what is causing it. Things are not as bad as when he'd disappeared into London with that wretched Trevor boy, but his not being contactable means she's spent ages catastrophising about what might have happened to him.

This morning, she could no longer just sit and fret. It had seemed like a logical step to contact Doctor Willis, the young man at the Student Counselling Service who had called her back in May. _Perhaps he will be able to help._ After all, the doctor had echoed her concerns about how her William was coping with the term's stresses and strains. For all she knows, William might have been talking to this chap about the idea of staying in Cambridge for the summer. If she finds out that Willis has encouraged it, she will give him a piece of her mind.

The music stops in the middle of a particularly trite part of Summer, and the receptionist returns. "Thank you for waiting. You asked for a Doctor Willis?"

"Yes."

"There's no one here by that name."

"And it took you this long to establish that fact?" _Wonderful — now even this route is closed. The man must have left the practice_. "Then, can you tell me who has taken up the role of counselling my son? I'm Professor Violet Holmes," she articulates meticulously, "and my son's name is William Sherlock Scott Holmes; he's a medical student at King's."

"Bear with me for a moment."

The music resumes exactly where it left off, and Violet shoves the phone away from her ear in annoyance. This — being fobbed off and kept waiting — is the hardest part of interacting with the endless stream of medical and other professionals she's had to deal with over the years because of William's problems. It's exhausting; other parents can breathe easy once their children leave home for university or other kinds of further education or jobs, but it was clear from early on that Violet's active role would never end.

Eventually, the receptionist cuts the music off again. "Mrs Holmes? I can confirm that we do have a Sherlock Holmes registered here, but I am unable to discuss the specifics of his case. Student confidentiality is something we have to take very seriously. I'm sure you'll understand."

"In that case, if you might tell me which practice Doctor Willis has transferred to, I could speak with him directly."

"Mrs Hol––"

" _Professor Holmes_."

"Professor Holmes; we haven't had any staff changes in two years. I've worked here as long, and there's never been a Doctor Willis here. I had to check with our director that he hadn't hired any summer locums I wasn't aware of. Are you sure you meant to contact the Student Counselling Service and not the GP surgery your son is registered with?"

 _I can't be remembering it wrong, can I? I distinctly recall he said Willis was from the Counselling services!_ She leafs through the pile of notes left on her desk and finds the right one. It confirms that the person who'd called her had specified they were from this precise university service. "This is most peculiar. Could I have heard the name wrong? Do you have someone else there whose name sounds like Willis?"

"No, I'm, afraid we don't. I'm sorry I can't be more helpful," the receptionist tells her. "Perhaps you should speak to your son's assigned Director of Studies at his college."

Violet hears a phone ringing in the background.

"Because it's summer and we're short-staffed, I'm going to have to get that, so goodbye." The receptionist cuts the connection.

Violet is stunned. _Who the hell was this Doctor Willis, and why had he asked all those questions? Why are they denying that William had been in touch with them?_ She scrambles for her phone book and finds the number for the King's porter before she panics any further.

The phone is answered by the same man she'd spoken to before.

"This is Mrs Holmes again. I need to speak urgently with my son's Director of Studies." She regrets not using her academic credentials for emphasis before when she'd spoken with this person.

"Medical student, isn't he?"

"Yes, of course. It's Holmes, William Sherlock," she emphasises. How many students named Holmes could King's College have? How is it that the people she's entrusted to look after her son seem to have a very tenuous grasp of who and what he is? 

There's a rustling of papers. "That'll be Associate Professor Benington. According to the monthly college bulletin, he's left for the summer to do research at the Mayo clinic and won't be back until August, so he's unavailable. Can't help you; sorry."

"Unacceptable. You will find me the number he's left with the College to be used in case of emergencies." Violet knows from her own work at Imperial that every university has to keep track of the whereabouts of its academic staff during the summer in case there are issues arising, for instance, from the students' exam results.

The porter says he will do his best, but it takes almost an hour before a number is found and he calls her back.

Without thinking, she telephones the number in Rochester, Minnesota.

On the sixth ring, it is answered with a sleepy, "Hello?"

"Am I speaking with Professor Benington?"

"Yes, you are. Have you any idea what time it is?"

"I am perfectly aware of the time difference, but this is a matter of urgency. I'm Professor Violet Holmes, calling about my son William, though I believe he goes by Sherlock these days."

There's a rustling of bedding and a click — Benington must have turned on a bedside lamp. "Ah, him."

 _Finally, recognition appears to dawn on at least someone._ "When did you last speak with him? No one at King's seems to have kept any track of the college's students, my son's phone is disconnected, and I'm very concerned that I haven't heard from him."

"It's summer vacation, Mrs––"

" _Professor_."

"Professor Holmes, it's summer vacation, and I believe Sherlock is working at one of our research groups as a laboratory assistant. College rooms must be vacated at this time, so perhaps he's simply forgot to give you the number to wherever he is staying until the next academic year's courses start at the end of September."

"I have a number for his flat but, _as I said_ , have been unable to reach him," Violet repeats. _Why can't people follow even the simplest of conversations these days?_ "Which research group would that be?"

"Neuro-immunobiology, as I recall. You can get in touch with them if you call the Neuroscience Centre."

"When did you last speak with my son? Are you not supposed to have regular meetings with him?"

"Our next meeting isn't scheduled until August; that's the annual progress assessment. I spoke to him three weeks ago. He hasn't spoken with you about the matter we discussed when we last met face-to-face a month ago?"

 _What matter?_ "No, not at all."

"It was a disciplinary issue––"

"Oh, of course. What's he done?"

"Sherlock has not done anything wrong, Professor Holmes — quite the opposite. He came to us with evidence of serious professional misconduct by one of his fellow students, a Mister Sebastian Wilkes. While the investigation is underway, Wilkes has been put on academic probation, and he could face dismissal when the Disciplinary Board hears the case."

"Well, that was unusually sensible of William, then."

"William?" Benington sounds tired a bit confounded still.

"Sherlock is just a middle name he's adopted on some whim."

"Oh."

If William had done a good thing, then what Benington has just told Violet doesn't really explain what's going on. "Then whatever could be the matter with him? Why wouldn't he talk to us about this? It appears he's stopped attending the counselling he sought; I was so happy to hear he'd finally disclosed his disability."

There's a short silence at the other end before Professor Benington responds. "Sherlock has not officially disclosed any disability. When I spoke with him about it, he was adamant that he has never sought or wanted any special treatment or adjustments to his studies and would not do so in the future. I have to say it was quite frustrating; what he told us appeared to explain many of his difficulties in his studies and in relating to other students."

"Of course, it explains everything! I just don't quite… There was a physician who contacted me from the Student Counselling Services, saying William had disclosed his diagnosis and given permission from them to ask me some questions. Yet just now, I was told by the same people that no doctor by that name exists."

"Professor Holmes, what was the name of this physician?"

"Willis."

"Right. Well, I regret to inform you that the person in question was probably Sherlock's peer posing as an occupational physician. These are the very grounds for Sherlock's complaint that could lead to Sebastian Wilkes' dismissal."

Violet frowns. _Why on Earth would some student seek to trick me like that? William must have angered them somehow._ "What a dreadful business! But at least there's the silver lining that it is now all out in the open and William can get the disability assistance he needs. He's been so stubborn about it, but it's part of a physician's education, isn't it, to be a realist?"

"We cannot extend him any additional support or resources unless he makes an official disclosure. He made it very clear he wants none of it; he was outstandingly well educated about his rights."

"But surely––"

"In fact, I may be in breach of confidence even speaking to you right now. The mitigating circumstances here are that you had been pulled into this unfortunate affair by Wilkes. Sherlock is not a minor, and he is not classed as a vulnerable adult as far as King's College is aware. This means Sherlock makes the decisions."

"But you are his Director of Studies! Surely there's something you can do!"

"I urge you to try to contact your son again, Professor Holmes; his summer internship has begun so you can reach him at the research group. There is nothing further I can do from where I am right now. Goodnight."

  
_______________  
  
  


Two days later, Violet sets out from West Sussex on a mission. George is driving and trying to deal with the traffic. They'd left at the crack of dawn but still found the A26 busy. By the time they reach the M25 just north of Sevenoaks, it is the height of rush hour.

She is sitting in the passenger seat, trying to keep from fidgeting. "Why do they call it rush hour? No one is going anywhere in a hurry."

Traffic is crawling at no more than twenty-five miles an hour. Occasionally it speeds up to all of fifty, only to come to a stop at Dartford on the approach to the tunnels under the Thames.

"Be patient, my dear. Everyone else is in just as much of a hurry as we are," George replies.

Violet spends most of the journey quietly fretting about all the possibilities. _What could have happened to William?_ After she'd managed to get the secretary of the research supervisor on that neuroimmunology project on the phone, it took the supervisor a whole day to get back in touch with her. He'd said that William had signed up for the project, done the induction, attended work on two days and then disappeared. No, the man had no idea what had happened, and he had no more luck getting an answer to his phone calls than she had. _'It happens, Mrs Holmes. Students' idealised notions meet the realities of what it's really like being a junior research assistant. Hardly surprising that some of them decide they'd like a holiday, instead.'_

It was enough for her to announce to George that the two of them were going up to Cambridge to find out what the hell has happened to their son. George had tried to downplay the issue until Violet had told him about the disappearing act from the research job and the disciplinary process.

She now revisits the topic. "If it's a case of bullying, and it sounds like it was, then William will have reacted badly to it. That student who lied to me to get details about what William was like as a child, well, for all I know, William is now blaming me for all of it coming to light. It would be very typical of him, as would be to refuse to consequently speak with me. Taking the phone off the hook could be precisely that, punishing me."

"He can't _know_ it's you on the phone, dear. And you said that he didn’t get your letter."

"Nobody else calls him, do they? And _yes,_ that most unhelpful porter said it was still in his pigeonhole. It's as if you don't care what might have happened to him!"

She can't help snapping at George; it's all well and good for him to counsel patience. When has he ever had to pick up the pieces when their younger son came apart at the seams? George's approach to William even as a baby was just to let him scream until he calmed down on his own. When the terrible threes hit, it began to dawn even on George that any adult's patience would run out before William's marathon tantrums would end. _Father always retreated, so it was Mummy to the rescue._ On more nights than she cares to remember, both mother and son were eventually in tears and fell asleep utterly spent well past midnight. Through years of fighting over food choices, of desperately trying to instil routines in a child who resisted them as hard as he could, of finding skilled professional assistance to help him blend in with others, George had stood by and watched as Violet did all the work. _It was always just the two of us against the world, William and I._

George doesn't rise to the bait. "Maybe that man you spoke with at the research group was right; he may have just gone off for a bit of a holiday with friends. He's been working hard, deserves a break. For all we know, he's got his feet up on a beach somewhere sipping a beer."

Outraged, she turns to glare at him. "What part of our son's autism makes you think he'd _ever_ choose to do any of the things you've just described? Have you developed some manner of dementia that has wiped away all memories of his tantrums at the feel of sand under his feet when we took the boys to Norfolk? He hates the taste of beer. He never had any friends!" _Save for that awful Victor, and I would hardly designate someone a friend if all they had to offer was encouragement to develop a drug problem._

"Who knows, he might have made some. Or just gone on his own to London. At his age, I wouldn't have wanted to be stuck all day indoors poking a pipette into a tray of test tubes."

Violet has no words to explain how frustrated she is at her husband's blasé attitude, but then again, this is nothing new. It's not even optimism George has, it's a dismissive hope that he won't have to work at whatever William needs — that their son could just fend for himself. Either he's not worried at all which, to Violet, is incomprehensible, or he just hopes things will blow over.

George had managed to convince her once that of _course,_ the boy could manage at Harrow, and the end result was a seemingly endless series of meetings with the educational supervisors, and eventually, William ran away from home after taking his A-levels. _How much evidence to the contrary could George possibly need to see reason?_ Violet can sense that something has gone wrong; _call it a mother's intuition or just the culmination of the past four years of worrying about William's choice of medical school being a case of biting off more than he can possibly chew_. She just feels it in her bones.

Arguing with George about it is not going to help, so Violet doesn't say another word until after they turn off from the M11 onto the exit for the A603 into Cambridge. That's when she gives him the directions to the flat, the ones she'd managed to get from the landlord last night. Finding contact information for the man had taken some serious detective work on her part since she only had an address for the flat. William had not bothered to give it to her, only a phone number — _so_ _typical of him!_ — but the research project manager had it on the HR form.

"Once we're across the bridge, turn as if you are going to Kings, but then almost immediately turn right onto Lensfield Road. Take your first right onto Hills Road. Once we pass the botanical gardens, the road crosses the train tracks, and we should look for the left turn onto Cherry Hinton road. We're looking for number 210, where the landlord is going to meet us. He said it's on our right, across the street from the Boots Chemist, the front door is between the Golden Buddha restaurant and the Maharani Restaurant."

As soon as they cross the train tracks the housing changes: terraces of two-story brick homes, more modest than those closer into the centre. By the time they reach the upper 100s, the places look a lot more run-down, many of them split up into multiple-occupant flats.

Violet spots what must be the right row of small, terraced houses where the ground floors are now takeaway restaurants and little shops. "Here."

George finds a space in front of the locksmith's shop, three doors down and turns off the engine. "We made good time despite the rush hour; only ten minutes to wait before the bloke shows."

"I'm not waiting."

Violet has her seatbelt off, and she's out of the car, striding to the brown doorway between the Chinese and Indian restaurant shop fronts. By the time George has locked the car and joined her, she's found the doorbell and is jabbing it repeatedly. There is no response from the little intercom box on the wall, so she bangs the doorknocker down a couple of times.

When she realises that William is either not home, or not coming down to let them in, Violet's fears start taking hold of her breathing.

"Well, at least he won't starve." George cocks his head towards the two ethnic restaurants.

Violet knows he is trying to get her to relax with humour, but it doesn't work. _It never has_. In the space of less than a hundred yards, she counts five takeaway shops, a mini-mart, a betting shop and the chemist. "Convenient perhaps, but hardly nutritious."

She closes her eyes and shakes her head. "Why didn't he keep his rooms in college? At least there, the refectory would have offered him a balanced diet." Then again, she has long suspected William has been lying to her about having regular meals in the communal dining hall.

George shakes his head. "Does King's even allow that over the summer? This is closer to the hospital and that research project. And it's actually quite well-served for all the essentials."

"Trust you to see the bright side. You never fear the worst, do you? What a nice world you live in."

The escalation of their sniping stops when they realise that a car has pulled up and double-parked in front of another car at the Chinese. A rather large middle-aged man gets out, looking straight at them.

"Mrs Holmes?"

There is a foreign accent in his question, but she can't be bothered to work out which Eastern European country it's from. "Yes, You're the landlord?"

He nods. "Mister Przybylski."

 _Polish._ "Then please let us in."

He frowns. "Young man, Sherlock, no answer when I phone, so not in. You can have look round but can't stay in there when he not at home. He work at hospital."

Violet really doesn't want to waste time on the whys and wherefores. "I've spoken to his employer; he's not there! He may be ill; please let us in _immediately_."

Mr Przybylski shrugs, pulls out a large key ring with dozens of keys on it, and carefully picks through them, slowly looking for the right label. Violet has to fight the temptation to grab the keys and do it herself.

Eventually, he holds one up. "I think this one." He unlocks the door and steps inside, with Violet and George right behind him. "Ah, not here. Look, see… mail on the floor." He chuckles. "Rent unpaid since last week; maybe he take runner? Students," he scoffs, then complains something long-suffering in Polish.

Violet glances down at the junk mail and fast food flyers that have been stuffed through the letterbox and then pushes by the landlord to start up the very steep and narrow flight of stairs. She calls out loudly, "William? _William_!"

There is no answer. She can hear George and the landlord coming up behind her, but she's quick. Fear makes her climb the stairs fast enough to make her have to stop and catch her breath.

There is a door off the little landing at the top of the stairs. She reaches for the knob and is relieved to find that there is no lock on it. Opening the door, she strides in for three steps before she stops and surveys the scene. She's walked into a small sitting room with a big bay window over the shop. The furnishings are spartan: a tatty sofa, its cloth loose textile covers sagging and stained at the arms, a side table with a lamp that has a dented shade, and she spots the overflowing ashtray that explains why the room reeks heavily of cigarette smoke. There is a single pendant lamp hanging from the ceiling, the shade yellowed with age and soiled by flies. It's the desk that tells her that her son is living here: piled high with medical journals and scribbled notes in his handwriting. There's his laptop, plugged into a socket and a printer on the floor. Books are strewn everywhere, from the desk to the floor.

She abandons the sitting room for the door to the right which opens onto a tiny galley kitchen, lit only by a skylight. The gloom doesn't disguise the smell. Violet finds a light switch and scans the room: there are dirty dishes have piled up in the sink, and the rubbish bin is overflowing. From the scent, she guesses William must have been alternating between Chinese and Indian.

She opens the fridge to find the culprit for the sour smell: a quart of milk, barely opened yet gone off, and a lidless container of something unrecognisable where the fats have rancidified. She closes the door, holding her breath to avoid nausea.

"Violet. He's in here."

It's George's voice, and the tone of it tells her everything she needs to know. She flies from the kitchen to the other door where George is standing on the threshold. She pushes past him and looks into the tiny room, barely big enough for a single bed and a wardrobe.

The room is dark, curtains drawn. It's hard to see, but she knows there is no one in the bed because her eyes have found what she has feared on the floor. William is sitting there, squeezed between the bed and the wardrobe. His knees are up to his chest, his head is down, and he is rocking very slowly.  
  


_______________  
  
  


Three hours later, after another battle with the traffic, Violet's younger son is silent and unusually compliant as she leads him upstairs to his old room with her arm around his shoulders. He'd tried to duck away from the physical contact at first but then gave up resisting — as if he lacked the energy to complain as he usually does when she tries to express her emotions physically. _He's never been a cuddly type, unlike our Mikey who always loved hugs from Mummy_. _It was the worst, seeing William so often upset as a little boy, yet trying to comfort him only made things worse._

George trails them up the stairs, and Violet can now hear uncertainty and distress in his pace. Gone are the dismissals that anything could be wrong, absent the clumsy attempts at ice-breaking humour. She can almost sense him wanting to retreat, to offer the only kind of support he knows by being in the proximity but not close. This is how it's always been: others keep their distance while Violet attempts to look after William.

In the car, George had suggested he might just be _'under the weather; a touch of the flu, perhaps?'_.

In the backseat, Violet had pressed the back of her palm on William's forehead where the boy had curled up with his side against the seat, eyes closed and his knees pulled up, facing away from her. He didn't react to the intrusion — not even with the usual flinch of someone touching him without warning.

"He's not warm, not sniffling or coughing," Violet had announced, and George had left it at that.

Once they're in his old room, William wriggles free from her and slumps down to sit on the bed like a rag doll. He then settles onto lying on his side, facing the wall. He had barely even acknowledged his parents' presence at the flat or in the car, and the same level of dissociation seems to be continuing.

Concern is a lump in her throat which Violet cannot swallow down. She covers him with an old, woollen blanket left on the backrest of a chair. She sometimes reads here when the house feels particularly empty and has brought the blanket up; she knows William hates the feeling of wool, but on top of his clothes, it should not be too offensive. She doesn't know what else to do besides keep him warm and comfortable since he had been hugging his arms around himself in the car, shivering slightly as they left Cambridge.

 _He looks so skinny_. It is far from the first time that stress would have decimated her son's appetite. She wonders, with a shudder, how old those takeaway boxes may have been. George had found a roll of bin bags in a cupboard, and with the landlord's assistance cleared out the worst in the kitchen while Violet packed what she thought they might need to take with them. They had promised to pay the late rent and some more for three weeks, which would give them time to arrange for the rest of his belongings to be delivered elsewhere. _He's not going back to that dreadful flat._

Sitting down on the edge of the bed beside her son, Violet pats his hip, then gives his greasy, messy hair a few strokes. "Your father will run you a nice bath, won't you, George?" she turns to look at her husband, seeking confirmation in his eyes that he understands the gravity of the situation. He's never been that good at reading their William because he's never been around enough to learn how one should function around him.

George nods, visibly relieved at being given a task he comprehends, and which allows him to retreat. He disappears into the master bathroom down the hall instead of the smaller bathroom the boys had shared. That pleases Violet; _William has always liked that big, clawfoot tub that came with the house_.

"A nice soak and some dinner. You'll feel much better afterwards," Violet promises quietly, patting his younger son's shoulder before giving it a firm squeeze. He doesn't react. She is tempted to go for a hug but knows it would console her more than it would him.

"It's all over and done with," she promises. "You won't ever have to go back there. Not to that dump of a flat, not to Cambridge."

Her hand is shrugged off his shoulder as though in feeble protest of her words.

"We don't have to talk about any of it right now, but you will need to tell us what happened with that other student. Your Educational Supervisor told me he might be facing permanent expulsion!" She briefly considers telling him she knows that she had been duped by this Wilkes to revealing things he would not have wanted her to discuss with anyone, but she doubts he wants to be reminded of any of it.

There is no reply. William's eyes are closed, and he is still facing the wall.

How many times in their lives have they replayed this particular scene? She's lost count. _If he could just talk to me…_ _but he never wants to, as though I'm not on his side._ Violet rummages through her memories and realises that this is precisely how things had been around the time when William had been attending that dreadful village school. He'd retreated into mutism and refused to eat. _This has to be about bullying_. _He'll_ _never learn to be polite, to keep his head down._ "You weren't… physically hurt, were you? Was there a fight?" William had never been the aggressor in fights at school unless one counted inadvertent verbal provocation.

There's a nearly imperceptible shake of dark curls.

"Good, that's… good. Not much in a fridge, but I think I could rustle up some salmon and potatoes." Thankfully, those are on the short list of foods her William will eat without protest as long as there's no sauce involved.

_Did things really have to go this far until someone would start listening to me?_

She's going to start a list of people she will need to telephone. The research project leader, first off, to confirm William has left his post, then the college.

_Clearly, he needs to live at home, be looked after. Perhaps even George will be convinced now._

_  
_ _______________

  
"Mikey dear, you wouldn't _believe_ the squalor!"

Violet tries to keep the disgust from her voice, but she knows that her elder son shares her own attitudes towards cleanliness and personal hygiene. _William has never appreciated those anywhere close to the same degree; he'd only acquiesced to the associated demands of others when it suited him._ "Why on Earth he chose such a grotty little flat, I'll never know. He hadn't done laundry for ages, not had a shower or bath either."

"How is he now?" Mycroft asks.

It's been three days since the rescue operation, as Violet has come to call it. "Clean. Non-communicative. He has hardly said a word since he got home. He goes through the motions only if prodded. He hardly eats, even though he's skinny as a rake. His first proper meal he threw up later that night. I have to push him to get dressed, to brush his teeth, _everything_. Left to himself, I think he'd just lie up there, staring at the wall."

"What does Father think?"

Although it feels good to vent her frustrations and worries to Mycroft, it grates a bit that she should have to be doing it to him rather than her husband. It's not fair to trouble Mycroft with things that are a parent's duty; he has a very important job and does not need this kind of extra stress.

George had gone back to work after a few days of useless hovering; his company's meetings in London couldn't be put off any longer, he said. _He's acting as though this will just stop on its own if we wait._ "He's back at work, says that we should just let William be for a few days."

She tells Mycroft about the fracas with the other student and how she'd been tricked into revealing things about William's childhood.

This prompts the comment, "Well, that's enough to depress anyone, especially him."

"Your father and I are having arguments about what we should do. I want to take William to Doctor Firebrace here. I think he needs to be referred by the GP to get a mental health appointment at the hospital in Hayward's Heath. He needs help, Mikey, and the longer we put it off, the worse he's getting! He's not been like this in a long time!"

"Have you asked Sherlock what he thinks he needs?"

Violet seethes. Apparently, her elder son is siding with his brother when it comes to his choice of name. _Why did he have to latch on to something that would make him stand out even more? William is a perfectly good and decent name fit even for a royal._

"No," Violet replies firmly. "As I mentioned, _William_ is not responding to any direct questions, won't make eye contact. He won't do anything unless he's nagged to the nth degree and then it's like…" she struggles to put it into words. "It's like he's moving in slow motion. Every step, everything is happening ten times slower than normal. Something's seriously wrong, I just know it."

"I remember your many complaints about Doctor Firebrace over the years," Mycroft points out dryly. "He's hardly an expert on the likes of William."

 _Nobody ever is!_ Violet wants to shout. That's what people don't understand — that others can rely on the medical establishment and all kinds of support services when they need such things for their children, but after years of conflicting, often useless advice and experts who turn out to be even more clueless than her, she is tired and fearful of having _no one_ to turn to. And Mycroft and George just expect him to sort things out, to have all the answers.

"That's why we need a referral to wherever they do have some proper expertise. We'll take him to a private clinic if we must," she declares.

"I will gladly contribute to the costs if need be."

"Thank you, dear, that's very brotherly of you. I'm sure that won't be necessary. When will you visit? I'm sure it would do William a world of good, seeing you. Perhaps you could help him examine what he wants to do with his life."

"He's finally seen sense, then, about medical school? I'm glad."

"He's not said as much since he won't talk to me, but it's obvious, isn't it, that he can't go back? We always knew this was going to happen, but you know how he is — he won't accept a wall is hard unless he's banged his head on it enough times."

"He's not on drugs, is he? The way you described the place he was living in––"

"No, he's not. We went through his things, there was nothing like that to be found, and he doesn't have any fresh marks anywhere." Helping him into the bath on the first night back home, she would have noticed.

"Have you had him tested?"

"No, but if Doctor Firebrace suggests it, we'll of course comply."

"Some substances and their metabolites take weeks to clear the system."

"If you say so." Mycroft is working for a big pharmaceutical company, and he's very clever so he must know a lot about such things. 

Violet perches on the edge of the side table housing the phone. "Oh Mikey, when will you come see him? We could use you here right now. You're such a responsible, steadying presence."

_How on Earth have we produced such a night and day pair of children?_


	16. Treatment Plan

It's eight in the morning, and the house is quiet. George is reading the paper in the sitting room while Violet prepares breakfast. It'll be just toast, a few homemade condiments, tea, hard-boiled eggs — things she knows her youngest will eat.

Or _would_ eat, if things were normal. If things were fine, William would have been downstairs by now, most often an early riser who could make do with very little sleep altogether. He'd inhale a piece of toast before bouncing back upstairs to continue his strange projects.

Not today. William has now spent too many days in a most dreadful and frightening state: not talking, not eating, only dragging himself off the bed to go to the toilet. He needs direction with everything — as though he's forgot how to manage even the simplest things. Yesterday morning, George had coaxed him to have some fruit salad, but it had all come up moments later. Despite that, he doesn't really seem physically ill as far as Violet can tell, just… absent. She has seen him in a state somewhat similar to this a few times before, but he had been so much smaller, then. She'd hoped, even assumed, that he had grown out of it, learned to deal with the world well enough not to disengage like this. _He doesn't even get meltdowns anymore, does he? I wouldn't know. He won't tell me anything about what happened at Cambridge._

Violet's conversation with Mycroft late last night had helped her make a decision which George had agreed with: they'll take Sherlock to see their family physician. Dr Firebrace is old now, only works part-time at the local GP surgery, but he knows Sherlock well after seeing to all his paediatric issues from chickenpox to sprains. He's not an expert in autism, however. _Are there even any GPs who are, really?_ Violet is still certain that he will be able to understand the significance of the sudden changes in William's behaviour.

She goes to the sitting room, bringing George his usual mug full of steaming Royal Blend tea. "If he's not come down in fifteen, you should go rouse him and make sure he gets his trousers on. Our appointment's in an hour." It will take fifteen minutes to drive to the surgery.

"Perhaps I should take a tray up?" George suggests, folding away the paper. "He might not feel up to eating in the kitchen."

Worried irritation flares up in Violet. How would George know what William would feel up to? Neither of them has any idea at this point what's wrong with the boy. Mycroft had asked about drugs, reminding Violet that a lack of recent track marks wouldn't rule out things such as snorting cocaine or taking something in tablet form. Violet knows she doesn't have the means to rule the possibility out, but this is not how William had behaved when they'd visited him at that rehabilitation centre at which Mycroft had arranged a spot. This is also not how he'd behaved after being discharged from there. While using or in withdrawal, William had been an exaggerated version of his quicksilver self: restless, agitated and very talkative. After returning home from that successful rehab, he'd been timid and solitude-seeking but communicated normally if only to tell her to mind her own business. Stroppy she can deal with; silent is more worrying.

Violet had tried to speak to him again yesterday, to no avail. He wouldn't even react much to yes or no questions. At one point, after she'd asked if that Victor Trevor had been in touch, he'd met her eyes and shook his head, looking like he did have something to say but had no idea how to connect his thoughts to his tongue. In the end, he'd shoved her off the bed in a flash of irritation, then curled up under the duvet again.

On her way back to the kitchen, Violet pauses by the stairs to glance up. _Is that the problem, that Trevor boy? Does William miss him?_ _Had they met up again, and had it upset William? Why would he react so strongly now, after four years of the two of them not seeing each other? Or had something else gone wrong?_ Two days ago, she'd asked William if there was someone new he was interested in, a girlfriend or a boyfriend, and a flash of incredulous dismissal had passed through his gaze before he'd closed his eyes. _If it's not Victor, then could it all just be connected to that strange phone conversation, during which he insisted he hadn't declared his autism to the university?_ She'd tried to get him to say something about this complaint that Doctor Benington had mentioned, but once again, he'd ignored her. How could she help him if he wouldn't — or couldn't — tell her what was going on?

She goes to the kitchen and eats a hard-boiled egg standing up, not feeling very peckish herself. She doesn't believe Dr Firebrace will get more out of him than she has done, but clearly, her younger son needs help, and a GP appointment should at least get them the referral needed to point them in the right direction for the next step. Nervously, she reorganises the flowerpots on a side table. One of them, a yucca palm, is in dire need of water.

She glances at her watch again: twenty past eight. "You need to help him get a move on," she tells George who has just appeared at the doorway between the hall and the kitchen, mug in hand. "We're leaving a quarter to nine."

"Yes, dear," George replies and swallows the last of his tea.

________________

"William? I asked you something, and I'd like an answer."

Dr Firebrace's voice is calm and encouraging as he leans forward towards the boy who is slouching down in the patient chair with Violet and George standing behind him. The GP has been asking him many questions, none of which have received answers. William seems far away, fingers coiling into his trousers which hang loose on his thin frame.

"You see, now?" Violet demands, "He won't talk to us, either, and the college staff have been absolutely useless!"

"Has something happened, William?" The family physician brings his office chair around the desk and closer to his patient, sits back down and leans forward.

William's lips move a bit, a very quiet mutter, and he's looking at the floor.

"Come again?" Dr Firebrace asks. Violet opens her mouth, but he raises a palm.

"Sherlock," the boy repeats in a whisper which Violet can only barely pick up on.

"Sherlock is what he's told us to call him," George says. "Says he prefers it to his first name. He's been using that name at Cambridge, too."

Violet nearly snaps at him. _Why is that even relevant, now?_

"Apologies, Sherlock. Old habits die hard, don't they?" Dr Firebrace is smiling. "Would you like us to talk without your parents present? Would that be easier?"

There's no response which is just as well because Violet resents that idea. "He won't talk to our Mikey, either. I offered to get him on the phone for William; his big brother has been so worried, too."

Dr Firebrace seems to have grown weary of his mute patient and pushes his chair back behind the desk. "I'd like to do some basic tests, rule certain things out such as hypothyroidism and anaemia. Is he on any medications?"

"No, he's not. He's been very healthy in recent years," Violet replies. "Well, apart from being skinny as a rake as always; honestly, getting some healthy weight on him is impossible now that he's not living at home," Violet complains. "I told him he should make use of College meals, but he never listens to me. There were no medications or drugs at his flat, either."

"I have to ask, just to be thorough: Sherlock, have you been taking anything that wasn't prescribed by a doctor? I know that students sometimes take things at parties." The GP's gaze is firmly settled on William, who doesn't react.

Violet sighs. _Dr Firebrace should stop wasting time and just ask me._ "He doesn't go to parties. Absolutely refuses to socialise, no matter how many times I tell him it's a two-way street, that he needs to make an effort to show other people he wants their company so they'll return the favour."

William is now picking at his nail in an odd way — he's shoving the cuticle down with his thumbnail in a way that looks rather painful. "Stop that," Violet hisses.

Of course, he doesn't obey her, because when has her son ever made an effort to reciprocate, to do his part when other people are doing their very best to help him?

George places his palm on William's shoulder, which elicits a flinch and a shudder. It doesn't get shoved away though, not even when George gives the shoulder a pat.

Violet, as angry as she is frustrated, crosses her arms. _Why is George rewarding him for being so uncooperative?_

Doctor Firebrace leans back in his chair and addresses Violet and George. "We'll add a simple screen for common drugs to the blood tests. You said he's been like this for the past five days? It makes it unlikely that he'd still be under the influence of something taken in Cambridge. I assume it's not possible that he's continued taking something at home?"

"We packed everything we brought back with him from his flat, and all the clothes he was wearing that day have gone through the wash. There was nothing there," Violet replies.

"And he hasn't hit his head or had any symptoms of infection such as fever, or headaches, or…?"

"No, nothing like that. You haven't hit your head, have you, William?"

The response her question provokes is nothing. Just… nothing. It is as though Violet's son is not at home, has just left a shell behind. He'd turned to mutism and lethargy after Mycroft had left for boarding school the first time, and when he'd been bullied so severely at that dreadful village school, but he was a _child_ , then.

"I'm going to need to examine you, Sherlock, if that's all right? Would you like your parents to step out into the waiting room?"

A shrug would be a generous description of the minute jerk of William's shoulders. To Violet, it looks inconclusive and disturbingly automatic, like a cat shaking its fur reflexively when an insect lands on it.

___________

Sherlock has no recollection of getting in the car this morning. _Was it even this morning or… before?_

He has no idea if he's eaten anything.

 _It's over_ , he thinks, and the thought rattles around his brain like a coin in an empty glass jar. It's the only thing that registers properly, that thought, but he wants to be rid of it.

He's not sure the cardigan his father had coaxed him to wear is even one of his own. It smells like Mycroft's old room.

 _There's no way out_.

Thoughts of Cambridge and Wilkes and Victor and that whole entire mess have become so intense and intrusive that they shatter his sense of time and space. He's found himself standing in the toilet more than once, having forgot about what he'd gone there to do. He has no appetite, and it takes all the effort he can muster to leave his room just to take a piss.

Words are eluding him. He can _feel_ them, somewhere in the distance of the empty edges of his mind, well beyond his grasp.

The sense of finality is crushing. Everything that he tried to hide, the way he tried to redefine himself — all lost because of Wilkes. Sherlock knows it's his own fault: he had been incapable of letting the bastard off the hook by not reporting him, incapable of not letting that idiot get to him. Now, Wilkes is likely to tell everyone what he knows about Sherlock since the cat's out of the bag regarding what he'd done, and he'll be scrutinised by the faculty regarding how he knows these things. Sebastian will be in trouble, and undoubtedly, he'll take his revenge on Sherlock for that. Now, that bastard has no reason to conceal from the other students about who his Patient X case had been based upon.

And that's just only one part of the problem. What consequences will there be for Sherlock for revealing that he's concealed something that their instructors probably think a _responsible, realistic_ — Violet Holmes' words, of course — student should have disclosed? The worst-case scenario is that if they don't find a way to end his studies because of that sin of omission, he won't have passed the Psych exam, which means he'll be at least pushed out of surgery, shoved towards a "safe" specialism, in other words, one where people are not involved. He'll be shut away in a lab… if he can be bothered to continue with medical school at all. He won't have the same opportunities as others. They'll all look at him the same way he's been looked at all his life.

He can't finish his studies like that, he just… can't. He can't go back there and face them.

A near-hysterical, panicked laughter threatens to escape when his mind catches on to the absurdity that he's being subjected to the same procedures that he was supposed to have learned on the other side of the trench. _I was supposed to be the doctor, not the patient_. Wilkes has succeeded in making him one and robbing him of all power to do anything about it.

He'd let himself believe it would be possible. He was going to show everyone — his parents most of all — that his life shouldn't be defined by his limitations. His brain resists the idea that Violet Holmes might have been right in anything but, given his current situation, he wonders who the rational one has really been.

 _There's no escape, now_.

Not from the life he's feared all along, the life he'd tried to run away from with Victor. He'll be one of those people who never leave home, who are whispered about at family garden parties, and questions about his profession or work and relationships will be circumvented with pitying smiles. His mother will be there, always, hovering in the background, managing him, telling him what to do. He's ruined his chances of escape not because of anything particular he's done but because of who he is. Who he is means that eventually, people will pick up on the fact that he's different, and when he gets stressed enough about having to pretend, the mask falls. Why should he even bother to pretend, to try to pass for normal, if all it does is prolong the agony?

He'd reached for the moon. Now, he might be left with nothing but the endless told-you-sos of Violet Holmes. He'll be known as _'that poor woman's autistic son'_ , a puppet in his mother's campaign for praise and sympathy for her. He'll be the defining feature of his mother's life, the pitiful symbol of her sainthood.

Maybe he should have continued trying his luck with Victor. He could have lived on the streets. Anything would have been better than being condescendingly smothered to death by his mother, locked away into obscurity.

_I thought I was more than this. Victor told me I was more._

He sits up, suddenly noticing that it's getting dark in the room. It's not his room at home, he realises but doesn't even have the energy to be alarmed. Everything is annoyingly pastel and smells of plastic furniture and some kind of a floor cleaning solution. The blanket under him covers a bed much narrower than the one he'd had at his flat. Its linens are coarse to the touch, especially the bedspread which makes his skin crawl, but he can't bring himself to peel it off the bed and shove it underneath.

When he sits up, he can see a large, unfamiliar lawn through the double window.

_It's over._

There's no lock on the door, at least.

______________

Very late on the second evening of his stay at Edith Cavell Ward of Priory Burgess Hill, a private hospital specialising in mental health, Sherlock leaves his room.

The common area is quiet, dimly lit, and the darkness outside is seeping in through the large, curtainless windows. The ceiling is high, the light from the halogen lights yellowish. Furniture is slightly worn but clean and obviously high quality. There's a strange atmosphere of artificially constructed, flimsy homeliness. Even his boarding school had been cosier because there, students at least had the energy and motivation to make living spaces their own.

Private or not, it doesn't look very different from the units Sherlock had visited during the psychiatry course. It turns his stomach to consider he's in one of these places, now. For all the declarations from his mother through the years that the last place she wanted Sherlock to end up in was some institution, Violet Holmes now seems very willing to push him into the arms of one since she doesn't know what to do with him. _She never did_. Sherlock is not dreadfully irritated over being brought to Sussex, but dumping him in some hospital––

 _How did I end up here?_ The last two weeks are a blur. After the term ended, he had managed, for a few days, to attend the summer research post he'd been awarded for an article he'd had published about a prior project he'd done at the Cambridge Neuroscience unit. Back when he'd been making plans for his future, he'd thought he'd like to do a PhD on the side; the theoretical side of his normal medical school course work certainly isn't difficult enough to take up all his time during terms. He hadn't anticipated how having to deal with new people at that research post would be the thing that drained the last dregs of his reserves. More than ever before, this term had underlined the need to fake, to pretend, to playact being something and someone he's not. The pressure Wilkes had put on him, and that stunt the boy had pulled… two days into the research post, he'd snapped at a co-worker because they'd been tapping a pen on a table, had a near panic-attack which had led to an hour spent in a cubicle in the men's room.

The morning after that, he couldn't make himself get out of bed. The alarm clock didn't even properly register in his consciousness. It had lain on the bed next to his thigh when he'd finally been able to stitch together two coherent thoughts late into the afternoon. He should have called the lab, but what would he have said? It had all just felt so overwhelming that he'd let the chaos in his head take over, hoping it would pass like some electric storm.

_Now, perhaps it has, but what sort of devastation has it left behind?_

Sherlock realises he hadn't put his shoes on. They're somewhere in his room, aren't they? Shoes are _allowed_ , are they not? He's been so lost in thought, so… _lost_ that he hasn't paid any attention to his surroundings or his clothes.

The wall clock says half-past eleven in the evening when he finds a forty-something woman with a name badge hanging off her belt is filling the dishwasher in the open kitchen in the middle of the common area.

"Hey," the woman greets him, stretching her back after tending to the dishes. "Nice to see you up and about, William."

He clears his throat, dry and hoarse from disuse. "Sherlock."

"Excuse me?"

"Sherlock. Only my mother calls me William."

There's a quickdraw smile, and the woman dries her hands in a tea towel. "Alright. I'm Lena. Can I get you anything? You didn't come down for dinner? There's sandwiches and juice boxes."

Dinner hadn't registered in his existence. He doesn't know if he wants anything. "Just water?"

She goes to the cabinet above the sink to retrieve a plastic beaker.

"Where is everyone? Am I the only one here?" Sherlock asks. He hasn't been paying attention to whether other sounds, other voices besides his own breathing could be heard.

Lena gives him a glass half full of tap water. "No, but we're only half full at the moment. There are ten beds here. Meds tend to tire people out; most are on something to help them sleep, so things get quiet early around here."

He's not on any medications, is he? Sherlock doesn't think so but can't be sure. There's a faint recollection of being offered something like that when he'd arrived, but he has no idea if he'd accepted. He'd just wanted to sleep and not talk to anyone. There are some fractured recollections of people talking at him, but they were incomprehensible, uninteresting. _Everything_ is uninteresting, and the thoughts which still threaten to take over if he doesn't purposely push them aside keep circling the same upsetting loop of what has happened in the past few months. _None of it can be changed, now, so it's all pointless to think about._

At least tonight, he feels more like himself than he has in days; if his brain chemistry was being altered by pharmacological means, he'd expect to feel odd, slow and hazy, instead.

He doesn't like the idea that the nurse seems to know who he is, but he can't recall meeting her. "What day is it?"

"Thursday. You got here on Tuesday afternoon and really seemed to need your rest."

He frowns, trying to understand what that means. At his childhood home, he'd felt painfully restless yet also lethargic, unable to rest because he kept sensing the presence of his parents, expecting his mother's demands and interrogations. He had felt harried, chased, haunted but without an ounce of energy to do anything about that. Most of those feelings have evaporated. He should feel uneasy due to these alien surroundings, but mostly he just feels empty, resigned and anxious about himself.

The nurse studies him while she takes the first sip. "Have you got everything you need? Your parents dropped off some things earlier, clothes and such. You were sleeping, then, so they didn't stay long."

His mouth is dry, he realises. _Drugs or dehydration?_ "I'm not on any meds, am I?"

Lena worries her lip, possibly evaluating what is pertinent to tell him and what she should conceal. "It was discussed at your intake interview, but your mother said you don't react well to benzodiazepines and that other meds had been tested which produced rather unpredictable results. It was decided that we'd hold off until you'd had time to settle."

"What's my diagnosis?" Sherlock knows that those medical magic words will dictate how long he needs to stay here and what things may be forced on him.

Lena's smile is tight. "Pending, I think. You should discuss that with your psychiatrist tomorrow. Aren't you cold?"

He realises his arms have goose-bumped; he's only got a T-shirt on.

"I think you came in with a cardigan. Should be in your room," Lena promises.

It's oddly consoling that he gets to wear his own clothes. At other kinds of hospital wards, patients are dressed in demeaning, baggy pastels which flatter nobody. _Cogs in the machinery. Clones. Know your place._

Even the white coats and surgical scrubs he's been wearing as a medical student at non-psychiatric units have felt uncomfortable — as though he was being boxed in and told to adopt a role into which he didn't quite know how to fit. He'd still done it willingly so long as it meant they didn't point fingers and call him out for being an imposter. He doubts that any students besides law and medical students were given so many instructions on how to behave, how to conduct themselves. It's all part of the _let's-make-everyone-into-clones_ game that the medical profession seems to demand. Until Wilkes, he'd managed.

Why isn't he allowed to be the person he is, and still be able to be a good doctor? Why does everyone demand he fits into their definitions? His mother and father, Wilkes, the teachers…they all seem to have this view that someone like him can't do this and shouldn't even be allowed to try. He has built his recent life around the belief that he can, so long as the rest of them shove their expectations somewhere else. Until he'd been unmasked by Wilkes, the others had treated him as just being socially inept, unskilled at interpersonal relationships. Now that Sebastian has given them a label to slap on him, they will use it to try to deny him what he believes he can do.

 _Is the fact that I've ended up here evidence that they're right?_ Right now, staring at the nurse who is watching him through her peripheral vision as she finishes up in the kitchen area, he wonders when… no, _if_ he's going to realise at some point soon that maybe they are right and he is wrong. After Wilkes had done his deed, the doubts have begun whispering in his ear more frequently. _Why had I even longed to be a part of such a world? It was a mistake, wasn't it, thinking that neuroscience would be enough to make me endure all that interaction with people?_ He'd expected medical school to have a modicum of academic freedom, but instead, he was herded in with other students to endless group sessions, told what to wear, how to act, how to _be_ , and he always struggled and sometimes failed miserably. There isn't a single person among his peers of the staff around whom he could relax and be anything even resembling himself. Sometimes, after keeping up his mask of barely-normal, he's not even sure where that ends, and the real him begins.

Victor had been the only one who hadn't cared a whit about how Sherlock is different, and he suddenly remembers so vividly his first night in London with him. Victor had arrived in the city before Sherlock, taken a room at some dingy B&B in Soho. They'd left their things there and walked the streets until the early hours of the morning. That first night, on Blackfriars Pier, he'd snorted cocaine for the first time. They'd laid down on the cold pier, looking up at the stars occasionally visible through passing rainclouds. The happiness he'd felt had been partly manufactured by the cocaine lighting up his brain, but some of it had to be real. For the first time, there were no expectations, no one micromanaging him, no one telling him what to do and how to behave. He could just _be_ , and he had a friend with whom he didn't have to pretend to be someone else. It was a shame that it had ended so badly. He'd squandered the freedom with Victor, not been able to manage it into something that wasn't destructive. _Another failure._

He is startled to realise that right now, he has that same freedom, even if it means having to endure these bleak surroundings.

Water glass in hand, he glances around the room and feels a sudden, disconcerting flash of relief. At least here, neither the dean of the medical school or his mother makes the rules. He wants to leave, wants to get out, but where would he go that would be better than this? Back to Cambridge is not realistic — they can't possibly keep him on now that they know about his _deficits_. Home to his parents? _Hell, no._ He's escaped once; twice, even, if he counts Cambridge. It feels difficult to let go of thoughts of assignments, coursework, exams, OSCE practice, but it's also tempting. If he could only endure the crushing sense of failure, he could let go of all the things that have nearly decimated him in the past four years. His mother would applaud it. It would be easier than trying and failing.

_Let go of neurosurgery._

_Let go of what Wilkes did._

He doesn't know which one is harder. Both are a weakness that makes him hate himself even more. He realises that he may have been stupid to think the faculty would care about what Wilkes had done. Maybe Sebastian will just be reprimanded. That would mean he'd still have his career and his social circles while Sherlock is here, alone, and without direction. They will all feel vindicated now — his parents, his critics among medical school staff, the other students. The dream that had got him out of Victor's clutches, taken him through rehabilitation, set him on the path to medical school — shattered because of things he can't change.

He stares around the common area in utter despair. To end up here, of all places; the irony threatens to make him choke on the water he knows he should be drinking. Filled with an anger and a frustration he cannot express he wishes the water was in a proper glass that he could throw across the room to break into as many pieces as his dreams are in. It's Nurse Jonas's voice he now hears in his head explaining why there were no breakables allowed in the Poplar Ward: _'patients can get frustrated and take it out on objects, themselves or others. That's why we remove temptations'_.

Even though he'd declined food, Lena takes out a plastic-wrapped sandwich and a box of apple juice from the fridge and gives them to Sherlock. Once again, other people think they know better what he needs and should do.

He returns to his room, spitefully tries to swallow down a bit of both, which only ends with his head down the toilet bowl.

________________

The moment he's escorted in the psychiatrist's appointment room the next day, he springs the two questions which have been bothering him the most: "Why haven't medications been forced on me? Why aren't people telling me what to do?"

"Is that what you expected? Would you want treatment to happen without your agreement?" Dr Hayes, a forty-something woman in a slightly worn heather cardigan and brown trousers asks him.

"I'm not sectioned, am I?" Sherlock asks, suspicious.

Dr Hayes directs him into the chair opposite hers. "No, you're not. We do sometimes turn voluntary treatment into involuntary holds if patients resist the treatment they need — I assume you know all this? Your mother told me you've been doing your psychiatry course."

"So, I could leave?"

Even just the notion of that possibility surprises him and puts him more at ease. He's tempted to think it separates him from the patients he had met during his rotation, but that would be intellectually dishonest, wouldn't it? He's not different. He's here. _Wilkes would laugh and say this is where I belonged all along._

"Yes, but I wouldn't recommend that."

"I didn't come here voluntarily. Not… exactly."

"I'll admit it took some time to decide how to approach the situation. You didn't seem to be able to give consent, but you also didn't object." She fixes her rather intense gaze on him. "What all parties concerned agreed on was that you were in need of inpatient treatment."

"That's because my mother refuses to just leave me be. On what grounds was I admitted?"

"Your family physician, Dr Firebrace, referred you to us on suspicion of a depressive episode, possibly of a catatonic nature."

This causes Sherlock to have a double-take. Now that his head feels clearer, he has been assuming that initiating this treatment process is just a lifelong dream-come-true for Violet Holmes — to have him committed because of his autism, using what had happened at Cambridge as an excuse.

"Based on what?" He asks, hating how uncertain and wrong-footed he sounds. The old impulse to stay as far away from professionals like this is rising from the haze of shock and exhaustion.

"Apathetic mood, weight loss, mutism — though your mother said you have reacted to stress in such a way before without depression— fatigue, inability to make even the smallest decision such as choosing clothes; slowed movements and shattered concentration, refusal to eat or drink, disregard for personal hygiene."

Sherlock doesn't reply. These things must have been described to the staff by his mother, but can he contest them? He's not certain.

"Your family thinks this is connected to something that happened at university, or that the stress of being a medical student just got too much."

"I don't want to talk about Cambridge."

Dr Hayes leans a bit closer, trying to catch eye contact. "Do you think they're right?"

"No. Yes. I don't know. I'm not expected to know."

She is getting all of her information from his mother, and people always tend to just take what she says at face value, so why even ask him? He doesn't want that kind of politeness. "I don't want you to talk to my mother anymore."

"I won't if you prefer that," Dr Hayes says. "Do you want us to make a note in your file saying that your family doesn't get access?"

"I can do that?" He realises he's never considered such a thing since he's so resignedly used to Violet Holmes sticking her nose in all of his things.

"You're an adult; of course, you can. It's entirely up to you who we share your medical information with."

His thoughts instantly shift back to Wilkes' presentation. He had certainly not had any choice there who had access to his most intimate medical details.

"We usually arrange Family Meetings during the course of a patient's stay here, but they are not obligatory. We do recommend that family be present at the discharge meeting. You will be present at all of these, so you'll know what is being discussed. It's important that we plan your treatment together, that you get to have a say."

"I'll allow the discharge meeting, but otherwise I want you to keep my parents out," he says and feels almost intoxicated with this new power he has suddenly been given. This is _new_ — unprecedented and strange. "No access to any information."

Dr Hayes looks thoughtful, jots down something on a pad with a question mark at the end. "Very well. If you think that's what would be beneficial, then of course."

Nobody has ever asked him what he thinks he needs. Sherlock decides he rather likes this. "And I can leave if I want to?"

"Yes."

If he stays here, it's by _choice_. His choice, not something Violet Holmes has once again forced on him. That makes the concept much less frightening. At present, he doesn't want to even think about Cambridge, nor does he want to go home to Snowdrop Lane. He's already here, so his mortification over ending up in such a place is over and done with. It might just prove to be a safe haven for a while.


	17. Man's Best Friend

He gets assigned more people: a psychotherapist, a Case Manager. His mother must love this: so many professionals descending upon him like a horde of vultures. He'd still rather deal with them than her.

The therapist is a male psychologist barely five years older than him. A certificate of psychotherapist training and a PhD certificate have been hung on the wall. _Academic high-flyer, then._ Sherlock wonders why he'd chosen psychology instead of medical school. _It's not really neuroscience, is it, even if it's heavy on research, it's still the misuse of statistics based on subjective assessments and labelling of mental illnesses._ Being a patient rather than a provider of psychiatric services is not going to make him into a convert about any of this.

The psychologist is wearing expensive loafers, a jumper from a label favoured by people who sail. His hair has not been very meticulously styled, as though the man had given up trying halfway through. _Perhaps an outdoorsman instead of just someone to whom certain clothing is just a fashion statement?_ Sherlock wonders. There's a photo of a sailboat on a wall. _Not a very difficult deduction, but a useless one._

His brain does this, reads things on people, useless things, things that make them tell him to piss off or cause them to stare at him.

"You're a medical student, then?" The psychologist, who'd told him to call him Mark, asks as his opening move.

Sherlock picks up a decorative pillow and arranges it onto his lap. He wants to tuck his feet underneath him on the sofa, but he knows that taking off his shoes in an appointment room is not customary. ' _Don't act so odd, William_. _It makes people uneasy._ '

"I was a medical student, yes." That much should be blindingly obvious from his file, but then Sherlock remembers how his own supervisors had told him to start with easy questions to put the patient at ease. _I'm not at ease, nor will I ever be in this situation._

"When did you give up your spot?"

 _I didn't give it up; Wilkes took it from me_. "I haven't." _Yet._ He shrugs, expects to be asked something more difficult and stupid next — such as how he's feeling.

"Why do you think you're here, Sherlock?"

He is surprised that telling that nurse, Lena, that he prefers it has resulted in all the staff now calling him Sherlock. It helps him not be bothered that they talk about him behind his back; it's their job. When other students or medical school staff gossiped about him, it made his skin crawl — made him feel like he was walking a tightrope. Here, his secrets are on file, in the case notes, out in the open but protected by the law. He doesn't have to try to mask them. He can see them if he wants, they are his, and they're safe, for now.

"I'm here because I don't know what to do next," he admits quietly.

"Well, how would you like us to help you work that out?"

He looks up, and the surprise must show on his face. _What kind of question is that?_ This is the second mental health professional here who is asking what _he_ wants — the first had been the psychiatrist making sure he knew that he had full autonomy in deciding who had access to his medical information. He's as alarmed as he is confused by all this. His parents had picked this place, but this is nothing like the therapy sessions he's had to endure all through his childhood. This approach also isn't anything like what he's been seeing at A&E, and the acute closed wards. He doesn't feel threatened, at least not like he'd felt with the Counselling Centre neuropsychologist.

_It's a relief to be out of Cambridge._

"I think you need a bit more time to do exactly what you said — to take time to try to understand what's going on," Mark suggests. "Do you want to talk about your studies?"

Sherlock puts the pillow down, shaking his head. He can't help feeling a bit detached, as though a part of him still hasn't internalised what has happened. _Is this how people feel after an accident or some disaster? Do they need to keep reminded of what they don't want to remember?_ At times, curled up on his uncomfortable bed in his patient room, the very notion that he'd ever even been a medical student has felt ludicrous.

"Your parents think that something happened at Cambridge that's brought the world crashing down a bit," the psychologist suggests.

 _What an odd way to put it. How would the world crash down only 'a bit'?_ Is he ready to talk about any of it? Would talking about it ever be of any use?

Sherlock swallows. "What you just said… When you asked what I wanted while I'm in here, how am I supposed to know?"

It's a helpless thought, being asked to tell these so-called professionals how to help him push through whatever is going on. It's still better than the approaches of the people his mother had hired when he was a child who made him cry and told him to keep his hands still, hounded him for endless repetitions of exercises which were supposed to teach him how to pretend that he was like everyone else. He never felt respected or heard.

Now, he's being asked what _he_ wants, and it's making him deeply uneasy, as though there is a trapdoor underneath him ready to drop him into more confusion and uncertainty.

He doesn't want to be here — _who would?_ — and he doesn't want to leave if it means going home, where his mother will start telling him what to do and making decisions for him again. Is it worse to be treated like a patient than it is to be treated like a freak by his fellow students? At least here there is no pressure to be someone he isn't.

"Do you want to talk about something else?" Mark coaxes.

"No." Without caring about etiquette and proper manners and dirt from his shoes getting on the sofa, he pulls his knees up, hugs them to his chest. "I just want people to leave me be."  
  
  


_________________

Mummy is — unsurprisingly — shocked and livid that he has banned his parents any further access to his medical information. She lectures, splutters, complains and berates him for half an hour during a family visit, and Sherlock manages to tune it all out. He won't relent. He's beginning to wish he'd banned them from coming to see him. Trying just tell his mother that she's not welcome would not help, she'd just ignore it and try to spin things so that the staff wouldn't interfere. _If there only was a way to make her understand that I don't want her help._ Whatever happens — if he starts feeling more optimistic about his future or doesn't — he doesn't want her to be able to claim it as her victory _or_ her failure. He won't let her. It can't be just about her anymore. It's a revelation that the staff here seems to think that as an adult, autistic or not autistic, he gets to decide for himself. _Still an adult, no matter what Mummy thinks._

During his parents' visits, his mother tries to talk to any staff member she can find about Sherlock, demands that his need for medications is re-evaluated. _As though that would suddenly make me welcome her micromanagement._ He is delighted to overhear the Ward Sister reminding her — quite sternly — that her son is here voluntarily and thus has the right to decline medications and to decide who is privy to private information. With the Sister still present, Violet raises the point that maybe the need for involuntary treatment should also be re-evaluated and gets told to wait until the family conference with her concerns.

Violet loses her temper. Usually, she's quite calm and composed if prickly when people rile her up, but something about this is putting her on edge. It's disconcerting for Sherlock to listen in from around the corner as his father tries to get her to calm down. _She has lost control, in more ways than one_ , he realises. She demands that Sherlock be re-evaluated somewhere else, somewhere where, quote: ' _there's competent staff who don't indulge William's whims of pushing away the people he needs the_ _most_ '.

He rounds the corner and faces her. "Who and what I need is for me to decide."

Lena, who's just arrived for the evening shift comes to see what the commotion in the common room is about, and Sherlock asks her to escort his visitors out. Father looks a bit crestfallen at this, and Mummy is furious in a barely contained manner Sherlock has rarely seen.

 _She's lost control,_ _and_ _she doesn't know what to do. That makes two of us._

________________  
  


  
A week later, he gets assigned a new psychiatrist when Dr Hayes leaves for a holiday. Usually, he's against new people, but Doctor Sheila Drew's approach seems to be very similar to Hayes'. Though they all know he's here because something went wrong at medical school, there is still a slight collegial feel to their interactions with him. They don’t talk down to him. They put the onus on him to explain things. Being allowed to engage as a fellow professional in the guise of a patient helps him feel less pathetic, less at the mercy of the system in which he was supposed to be a doctor, not a patient.

Yesterday, during their first meeting, Sherlock and Doctor Drew agreed to disagree on whether he should be on an antidepressant; he had pointed out that someone on the Spectrum might react to them in unpredictable ways, and that her insistence just might stem from the deluded notion that every patient in this place should be on at least _something_. Instead of being offended, she had laughed and told him they could let the topic simmer until their next session, which is today.

"I won't patronise you by explaining the effects of psychopharmaceuticals used in the treatment of anxiety. You will have covered this in your course unit," she had told him.

Today, she wants to explore another symptom. "On the Hamilton Scale, where would you put your level of anxiety?"

"I have occasional anxiety, but I don't currently have a diagnosable anxiety disorder, and that scale is relevant only for those who fulfil such diagnostic criteria," he retorts.

The wry smile stays on the woman's face. "And yet, here you are. Would you say that your anxiety has lessened during your time with us?"

"Yes," Sherlock answers readily. He has become convinced that the clinic is, indeed, neutral territory. He's had time to think about things, including how he'd arrived at this state. After a childhood filled with medical staff who didn't care about what he had to say, only about Violet's opinions, it is outstandingly hard for him to trust anyone representing that same lot. The fact that he's here voluntarily is what helps him talk, and he keeps surprising himself by wanting to do so. At least when it comes to the concrete issues he's facing, such as the continuation of his studies.

He sighs. "I know that I was disengaged… alright, _dissociating_ , from what was a stressful situation. Right now, I am in limbo. I don't know whether I will be able to return to medical school. I don't know if I passed my exams. I don't know if my exposure as neuroatypical will be used as an excuse to make me quit medical school. I don't know if the idiot I called out for a gross breach of medical ethics will be disciplined. I don't know a lot of things…"

"And do you feel anxious about that lack of certainty?"

"Wouldn't you?" If he lets his annoyance creep into his response, so be it.

Dr Drew smiles. "Is that irritability because you are anticipating the worst?"

He rolls his eyes. "Stop ticking boxes. When I first got here, the idea of limbo was… okay, I guess. No pressure; I could just drift. But that can't last forever, and I'm not ready to throw in the towel, admit defeat or whatever other clichés you want me to add in here. No, actually, I want to amend my answer. When I was brought here, I wasn't anxious — I wasn't _anything_. Rather than experiencing additional feelings, I was devoid of feelings in general. That has changed. That being said, let me reassure you that I am not experiencing startle responses, I am not easily moved to tears, I am not afraid of the dark or being left alone. I am not experiencing any more difficulty in falling asleep or staying there than I normally do. I don't remember my dreams. I have no hobbies besides reading and the violin, and since the latter is not available here and the book collection is deplorable, I can't tell you whether I have a lack of pleasure relating to them."

She starts to laugh. "You know your theory. So, no muscular or sensory issues, cardiovascular symptoms, respiratory, urinary or gastro problems?"

He often reacts to stress with his stomach and easily loses his appetite, but things have been better even with those in the past few days. That makes discussing any of it pointless. "No. And as you have observed, judging by what you just wrote down, I am not fidgeting more than I usually do." He refuses to use the word _stimming_. "I am not restless or pacing; there is no tremor in my hands or rapid respiration, no odd facial expressions. And I am not depressed. I am, however, pissed off."

Her expression changes to one that he decides is more serious. "Angry… about what?"

"That I am in this situation. It isn't _fair._ I've done my very best to fit in, to expend the inordinate amount of energy needed to pretend that I am normal. And yet, because of something an idiot fellow student decided to do to… I don't even understand why he'd bother to hate me so much instead of just ignoring me. Everything I have worked for is now threatened. I am angry, but it is a _legitimate_ anger. And if my mood occasionally approaches depressed, it's situational."

"When you first arrived here a week ago, your referring GP said you were not speaking or acknowledging communication from him or your family. You were withdrawn to the point of near catatonia."

He nods. "So I have been told. I don't remember much of it." _I wanted to feel nothing_.

"Why do you think that happened?"

"Sometimes… sensory overload and the stress of conforming to ideas of what a medical student should be can become overwhelming. Being exposed in public as… autistic was a breaking point. I felt that in a single stroke, everything I'd been working towards had been undone. That all my efforts had been for nought. That I'd been overly optimistic about my abilities to conceal things."

"And now? Can you summarise what you think has changed?"

He shrugs.

"Objectively, you've regained the ability to look after yourself, and you're communicating quite insightfully about your situation. Would you say you are _better_ in any way?"

"Yes, in the original meaning of that word, which is improved. I'm not saying I'm _fine_. Not yet…but getting there." The statement sounds false, even smarmy in that way Wilkes tends to talk to people. It's a lie because he doesn't know what 'fine' means. Has he ever been that? Is it just another phrase used to define 'normal'? As long as he can remember, he's lived in a heightened state of baseline anxiety, trying to anticipate the expectations of others, so does he even know what a normal amount of anxiety is? He'll never be 'better' when it comes to what makes normal things difficult for him because the way his brain works cannot be fixed — just as Wilkes had declared to his classmates. At home, at school, at Cambridge… the pressure to conform or fail has been relentless. Is this what his career after medical school would be like, too? If he's crumbling under pressure now, how could he manage years, _decades_ of this? Is it worth it, wanting to do neurosurgery?

 _All the world's a stage_. _It's just that others know their roles effortlessly by heart, whereas I keep needing a stage whisperer who doesn't exist, and it distracts me from what I really should be doing, which is studying and achieving what I'd originally set out to do_.

Dr Drew looks thoughtful. "You know that discharge depends on a treatment plan. What do you think should be in yours?"

He shakes his head. "I don't know. Not yet. Ask me again next week."

_________________  
  
  


It's day fifteen of Sherlock's stay at the Cavell Ward. Over the past two weeks, he's tried to avoid interactions with the other patients. He's consciously stopped himself from using what he'd learned in the psychiatry unit as a way of diagnosing them. He needs to focus more on what's going on in his own head at the moment, and the other patients are irrelevant to that. _They're nothing but a distraction, one that just stresses me out._

It's a Friday afternoon, and he makes his way into the communal area where one of the patients, a thirty-year-old bipolar postal worker, is being visited by what Sherlock guesses is his mother. What surprises him utterly is that the woman has a dog with her — a black crossbreed of some sort. The patient is ignoring the dog and barely talking to the woman, who has looped the lead around the leg of a chair and is telling the dog to lie down and be quiet.

As soon as Sherlock comes near, the dog looks up at him, and its tail starts wagging, thumping the side of the chair. Close up, he can see that it is young — more a puppy than a fully grown adult. There is mischief in the dark brown eyes that peer through its very curly hair. The dog leaps up and charges towards him, tipping the chair over in the process, making it smack hard on the floor in a great crash.

"Damn it, Dog! I told you to lie still!" The woman shouts.

Reflexively, Sherlock goes forward and collects the canine, going down on one knee to be on its level and giving the animal a greeting. It is clearly delighted to have someone paying attention to it and wriggles about under his hands. The smell of its fur as he lets it give his face a lick brings forth a memory: the farm close to their home and its owner's two collies he used to play with. When old Murray who owned the farm had a massive stroke and consequent pneumonia, his children sold the farm, and Sherlock had lost one of the few places to which he could escape the suffocating atmosphere at home created by Violet's relentless hounding.

The woman who owns the black dog is now striding across the room with an angry look on her face. The patient she is visiting turns away from the scene and stares out of the window, clearly uninterested in the drama unfolding.

"I'm sorry. It shouldn't have done that. It's supposed to sit and stay on command."

"It's alright. I like dogs. What's his name?" Sherlock can see it's a male. "How old is he?"

She sighs and cocks her head towards the man he's visiting, now out of earshot. "Just Dog… Frankie never bothered to name him anything else; got him from someone at work when he was in the mania that landed him here, and that's turned to one of his… other periods, now and of course he doesn't give a damn about fixing all the things he's gone and done during the manic one. God knows what possessed him to take him in the first place. It's me that gets stuck with looking after the loopy beast; there's hair everywhere, and he chews on things. Needs training, which I can't manage. Brought him here today to tell my son that I'm going to have to give him away. He's not coping with our second-floor two-bed flat. I'm due for a knee replacement, can't give him the exercise he needs."

Sherlock looks back down at the dog, who leans up and gives a tentative lick at him in the air as if in supplication.

"How old is he?" He repeats as they begin making their way back to the woman's son.

"Frankie, how old is the mutt?"

The man turns away from the window. "Not a mutt — a labradoodle. Sheds less, hypoallergenic. Think he's six months."

Sherlock looks at the patient properly for the first time. "Do you intend on keeping him?"

"Nah. It was just… an idea I had. Mum's right — it needs training. Space to run around in. I gotta work when I get out of here — if I ever get out of here. I've never trained a dog."

Sherlock can't pretend to possess such experience, either. His future is up in the air; he's got plenty on his mind, he knows this would be a distraction but wouldn't it be a distraction of a _good_ sort, unlike having to sit around in Sussex listening to his mother prattling on about his faults? A dog would get him out of the house without having to deal with people. He knows he's making a rash decision, but what good have his more carefully deliberated decisions brought him? All they've done are land him here.

The dog is now sitting leaning up against Sherlock's legs, and he doubles down to give his neck a scratch. He knows that it's mostly just puppyish enthusiasm, but he can't help being sad at the thought of this dog getting so little positive attention that it's acting as though it's Christmas. It's hard to think about him in a shelter. _You're just being you, not understanding what people expect, and they want to send you away_ , he thinks, relishing the feeling of the dog's soft, curly hair between his fingers.

"I'll take him," he hears himself saying.

"You can't have a dog in here."

He straightens his back, faces Frankie and her mother and forces himself to make firm eye contact. "I don't intend to take up permanent residence here, do I? If you can keep him until I'm discharged, I'll collect him and take him home. My family lives in a Sussex village; it's a cottage with a big garden. He will give me something to do, training and walking him. Better than turning him over to some rescue centre."

Frankie's mother eyes him warily. "How can we know you'll really look after him? What are you in here for?"

Sherlock bites his lip. A minute ago, she hadn't cared about the canine at all. "Good question, not a simple answer. Not sectioned, which should be enough for you to know." The dog nudges his hand, sniffing his palm, the hairy snout tickling.

She looks down at the dog, who does not look back at her. "He likes you." She sighs, then relents: "Okay. When you hear about your discharge date, tell Frankie. He'll call me, and I'll bring Dog and his stuff. I'll be relieved to see the back of him."

Oblivious of the cataclysmic conversation that is being had about his future, the black puppy is wagging so hard its hindquarters are swinging from side to side, his tail slapping Sherlock's shins.


	18. Fool's Paradise

The sun is setting just as Violet steps off the train at Haywards Heath station.

As promised, her impeccably punctual husband is standing by their car, parked right next to the station exit. George has arranged his weekly schedule so that he can visit William on the days when Violet needs to go to London; there is a lecture series in Imperial College's summer school programme she cannot reschedule. Thankfully, " _Predictive Analysis for Macroeconomics_ " is a course she's lead several times before so she can rely on last year's PowerPoint slides. Usually, she updates them every year, but this business with William has intruded on her concentration and her time management. Tomorrow's lecture, " _Demand Curves and Price Elasticity_ " is one she'll have to revise on the train to London in the morning. It is one lecture the contents of which students have told her they find very demanding. It's not her fault that students these days cannot be bothered to find anything out for themselves, to compensate for obvious holes in their basic knowledge. They'd rather waste time complaining to the teaching staff that their work is subpar. _If only they all were all clever and industrious as Mikey_.

She receives a courteous, habitual peck on the cheek from her husband just before she ducks to get into the car. "Did you see him? How is he?" She demands. She wouldn't put it past George to come up with some excuse not to go.

Once buckled in, George starts the vehicle. "More talkative than he's been, I must say."

"Was he willing to talk about what happened at Cambridge, then?"

"I didn't think to ask."

Violet rolls her eyes. _How will things ever be resolved if William isn't encouraged to talk about what is obviously the cause of all this? How does he expect us to fix things for him if he won't tell us what the problem is?_ "What did you discuss, then? The weather?"

"I'm sure his therapist and the other staff are trying to help him just as we are, dear," George placates her.

Violet scoffs. "As though he'd willingly cooperate with that."

It's always George's default approach to assume others will sort things out when it comes to their son. Burgess Hill could just turn out to be a most expensive wild goose chase. After Doctor Firebrace had told them that William might not be assessed within the NHS immediately, Violet had insisted that they go private. She wasn't going to sit around, waiting for him to get worse. She wasn't even sure what _worse_ would have entailed. William had stopped eating, ceased talking, did nothing.

George slows down to let a group of horseback riders cross the road; they must be headed back to the riding school off Slugwash Lane. "He had a suggestion."

Violet stops rummaging around her handbag for her lip balm. "Oh?"

"He's come by a dog. We never were able to allow him a pet as a child with Mikey's allergies, but perhaps that could be something to keep him occupied now."

 _Oh, good Lord in heaven. Has George gone round the bend, too?_ "A _dog_!? How on earth does one obtain a _dog_ at a hospital?"

"It belonged to a visitor. Apparently, it's still quite young, and the owner is keen to get rid of it."

"Whatever would we do with a dog, George? They are messy, and a lot of work."

"Do you remember when William was younger and used to spend all his free time at Little Walstead farm before Murray passed away and his sons sold the place?"

"He helped look after the horses, yes. I do remember how the horse hairs were everywhere."

"I believe he also took to Murray's two collies."

"Yes, he likes animals. But wouldn't that dog end up as our responsibility? You know how William always is with his little projects; he shifts from one to another so quickly, and the old thing gets forgotten about and neglected just as swiftly."

They park by the cottage. Violet delays getting out of the car, sensing that her husband isn't done with the conversation. It's rare for George to push for something like this. Usually, Violet proposes all the big decisions in their family life.

"William seems very keen on this dog. He asked me to propose the idea to you because he thought that coming from him, you would dismiss it."

"I am dismissing it. It's just one of his whims."

"Perhaps it would be a way to teach him responsibility; that's something you often talk to him about."

"Couldn't it be something smaller, less troublesome. A goldfish, perhaps? Do you remember when Mikey had one? It didn't do much, but with his allergies, it was a sensible choice, and less of a tragedy if it dies."

As a child, William had often dragged in whatever living creatures he could find outside, which Violet then had to chase out with the broom. When one of old Murray's horses had to be put down, William had appeared more devastated than Murray himself. _Giving him a pet would just invite more heartache he isn't equipped to handle_.

"He's lost a lot with this medical school thing, Vi. He doesn't quite know what to do with his life. Might do him some good to have something new to focus on." George unbuckles his seat belt but makes no move to exit the car. "We always had gun dogs in my family," he muses. "I enjoyed them as a child. They can be good companions, especially for someone who doesn't quite know how to deal with people. I wouldn't mind having a dog, as long as it was trainable."

"How do we know this one is? Sounds like some stray he's latched on to. He doesn't _know_ anything about dogs; how would he be able to pick a suitable one? Is it from a reputable breeder, at least?"

"He says it's a mix of poodle and Labrador. Judging by the way he explained it, it appears the dog has chosen him." George is clearly amused by this.

Violet isn't. "He must have spun quite the tale at you. I should have expected you to be more level-headed about his ridiculous impulsiveness."

"He needs a distraction. He needs something that will give him a positive experience. Clearly, Cambridge failed to deliver that."

Violet agrees but isn't sure at all that some untrained dog of God-knows-what-origin is a viable solution. "If he has to have a dog, then why can't we select something suitable? Small, something neat and tidy."

"You think he'd accept anything we suggested?" George says, quite sharply. "You always stress how stubborn he is, so for once, when he suggests something, it might be important to give it our consideration. It may be a whim, yes, but do you remember what that therapist who saw him for a few years at Balcombe said about pets?"

"That was when he was a child," Violet dismisses. Different things work for adults, of that she's certain. _Adults shouldn't need inanimate objects or animals as consolation._ Then again, she's had to accept a long time ago that many things about adulthood may well permanently elude her younger son. The idea of a dog reminds her of how they were only supposed to allow William his stuffed toys only if he behaved and kept his stimming under control. What incentive would a dog offer to deal with people in a proper manner?

_A dog would just allow William to avoid human company, won't it? That should suit George fine, but I always had a bit more ambition for our children._

It grates on her that George's first tangible suggestion on what to do or change in their lives to help William is so… so impractical. _He doesn't know how to deal with the boy, never has._ _It's unfair if he gets to just swoop in and suggest ridiculous things._ Violet has been the one to lose sleep over this, to worry herself sick trying to build the best life for their child. She still doesn't know how to make things easier for him, and not even all the so-called professionals have been able to prevent this, what she's feared all her life — that what he needs is psychiatric care away from home.

"I don't like feeling sorry for our son, Violet, because I don't think that's a good kind of empathy at all," George says firmly, his mouth a thin line. "But I can't always help it. I've always wanted to believe that with your great efforts, he could make something of himself. I'm not certain academic life would ever have made him happy. He's not a child anymore. He should get to make his own choices. If he thinks this is something that could make him happy, who are we to argue? He's not you or me, Vi."

"Or Mikey."

"He has no friends," George complains as though he's only just come to this conclusion.

"He has us, and his brother," Violet responds tiredly.

"And since he was an adolescent, he's scarcely talked to us at all about anything important and hasn't spoken to Mycroft since last Christmas. All I'm saying is that perhaps if he can get along day-to-day with a dog, that would be good for him. Everyone needs a companion," George says with a knowing smile directed at his wife.

"If a pet was something that would work, don't you think I would have already tried it with him the moment Mikey moved out?"

"Can we know if it works without letting him have a go?" George asks. "That's a part of it, I think, letting him decide."

"You want to reward his campaign of misbehaving, refusing us access?" How could William not understand that they need to talk to his Care Team to hear what's going on? They're the ones who will look after him after discharge. She's not prepared to commit to whatever silliness William might propose; she knows her son better than any medical professional every could during his three-week stay and knows how irrational he can be.

"This isn't about reward or punishment, Vi. I don't need to ask him about Cambridge to see that he's devastated. Never mind _why_ , exactly. He needs something new to move forward."

The insinuation is suddenly clear: their son requires something else than the two of them because they don't know how to provide what he needs.

Violet bites her lip, rage warring with something she doesn't want to name. A part of her is tempted to give in, to show her husband that it isn't that easy, trying to manage their son. _Let him try and watch his idea fail, now that he's suddenly interested in helping_. If the dog turns out to be a disaster, they can always get rid of it. She just hopes that it won't eat all the furniture, shed fur and infest the cottage with fleas before that.

"You really think we should give in to this?" It's so bizarre to witness _George_ suddenly pushing for something so outlandish to try to help their son.

George takes the key out of the ignition and leaves the car. Violet follows, and they head for the house.

He stops on the threshold and turns to face her. "He's unhappy and angry, and if this is what might get his mind off Cambridge, then I really think we should consider it."

Violet unlocks the front door. "We'll have a think on it. That's all I will promise him at this point."

George looks slightly sheepish, now, as he sheds his coat and puts it on the hook. "Well, that'll have to be quite a fast think; the owner is bringing the dog round on the day he gets discharged."

"So, it's all been arranged behind my back, then?" Violet turns to face him, dismayed. She's been sidelined, adding insult to injury. She rues her teaching day tomorrow means that it'll be George visiting William again tomorrow. They'll have the day to scheme together, and she'll be expected to just grin and bear it.

"You know our boy; he does things first and asks for permission later. I had nothing to do with it," George has the audacity to claim after so clearly encouraging this madcap scheme.

"So typical of him."

Violet shakes her head and heads to the kitchen. She is desperate for a cup of tea.

______________

Sherlock barely listens to a word of his discharge meeting. It's his mother's show, not his. She's nodding like a bobblehead, insisting on the more extreme version of anything that is suggested or even mentioned. Medications, therapists, anything. Thank God Sherlock can decline all that anything and everything since he's an adult, now.

Not that Violet remembers that. She talks over him and dismisses his opinions as though he was still six years old and doesn't understand anything about the world, but he's always understood more than she thinks. He may be bad at reading people and deciphering their emotions, but one thing has always come through loud and clear: to them, he's a disappointment so profound that anything he tries and fails at is his own fault for being stupid enough to try in the first place.

He has realised that, even if he had graduated as a doctor, Violet Holmes would have just been waiting for some epic failure to occur, only momentarily delayed. Nothing he could do would change her assumptions, so the best he can do is try to have as little to do with her as possible. _I can't ever prove her wrong so I shouldn't even try_.

It's just that staying out of her way will be immensely difficult to do if he's forced to live at home, now. He has no profession, no job, no income. What options does he have?

Sherlock tears out of the Family Meeting Room the moment the handshakes begin, ignoring Violet's spluttering apologies at his rudeness. His things are still at the ward, so they let him in, and he's relieved to see Frankie and Sally, the mother, waiting for him in the sitting area. She's holding the lead, but lets go of it the minute Dog spots Sherlock. The black puppy squeaks and runs to his new owner so fast that his paws are slipping a bit on the linoleum.

"You need a better name," Sherlock tells the dog who stands up on his hind legs, front paws on his thighs. "Maybe something that might appeal to the person you _really_ have to work on getting on your side."

_____________

Violet turns in the front seat to cast a suspicious glance to the dog filling William's lap. "Is it house-trained?"

"Yes."

"How do you know? They could have told you anything to get you to adopt it."

"It's a he, Mummy. The owners told me he starts carrying his lead around when he needs to go out. He's really clever."

Violet is very sceptical of such purported intelligence. "I've put newspapers on the floor in the kitchen. That's where he'll stay the night."

"No!" William protests, looking hurt at the very prospect. "He'll be in my room."

Violet turns back to face the road. "Mark my words, that dog will have the run of the household unless we set some rules."

"Have you come up with a name?" George asks, slowing down at an intersection.

"Fibonacci, Fib for short. I got the idea from the dog's mother's name: she's a full poodle by the name of _Forrest's Count Me In_. The person who'd sold the puppy to Frankie owned her."

"That should please you, Professor Holmes — naming him after such a famous mathematician," George chuckles.

"Who are these people who'd just give you a dog? How do we know it's not sick or… worse?" Violet casts another suspicious glance at the pair in the backseat.

"What do you even mean? He's been to the vet, had his shots," William complains. The dog has climbed out of his lap and is looking around the interior of the car a bit timidly. "Even though the patient who owned him had bought him on a whim, it doesn't mean they didn't do all the proper things to look after a dog."

"And now you've adopted him on a whim, too," Violet points out. "It's a living creature, not a toy."

"He knows that," George tells her in a tone vacillating between patient and exasperated.

  
_____________

Three hours later, when Violet takes William's washing up to his room, her son is asleep on the bed, a black bundle of curly hair against his back.

She wishes she could have hope that this will work, that it'll give William something that will help him get over the disappointment of medical school. Maybe she protects herself with scepticism — occasionally it seems that George is trying to tell her as much and wants her to rekindle some optimism for the turns their son's life might take. She just can't help wondering how many disappointments it'll take to break his spirit for good. She wants to protect him from further heartbreak, but William keeps fighting her, keeps insisting on a path of most resistance.

_____________

For the next two weeks, she lets him be, heeding the advice of the staff at Burgess Hill that he's going through a transition which requires time to process. She lets George help him fuss with the dog and is glad when the two tell him they've found a local training circle to make sure the dog can behave. She is immensely surprised when William agrees to attend the training. After all, there are people there he doesn't know. _At least the focus is on the dog's behaviour and not his._

It's an unhurried Sunday morning, allowing her to watch William at breakfast. Currently, he's scarfing down toast with his head buried in a book. _Thank God he's eating again._ Violet has tried to tell him many times that family mealtimes are not for reading, but George is undermining her efforts by taking his tea into the sitting room since the coffee table is better sized for spreading open the Times.

Hit by a sudden relief that William is back home and safe, she asks him if he'd like some lemon drizzle cake or scrambled eggs and bacon.

He shakes his head. "No, thank you, Mum." He turns the page on his book, hand reaching absent-mindedly down to scratch behind Fibonacci's ear.

This is a reminder that sometimes, when he's relaxed and not too preoccupied with something else, William can manage good manners just fine. Violet often wonders what truly goes on in her son's head. She doesn't ask, because he doesn't know how to express such things, does he? For all her efforts and after all these years, she doesn't understand the logic of his behaviour or the reasons he insists on wanting things he can't have. _Is it just teenage rebellion which has overstayed its welcome?_

George is taking his holidays, now, and Violet's summer school duties at the university are done. They'll have some nice, quiet family time together at home. She hopes that Mycroft will visit soon to give her a distraction from needing to focus on William all the time. _If only it wasn't so stressful, trying to guess at what it is William needs, and attempting to get him to accept the help._ Not once during his time in Cambridge has she been able to relax, to trust that he's looking after himself. She knew this crisis was inevitable all along, and it hasn't helped that her husband's way of dealing with is to snap his newspaper straight just as he's done and expect Violet to fix everything. She doubts that things would be any better or worse without the dog. Perhaps George wanted one, and that's why he'd so emphatically supported William's idea. She is glad that father and son have found something to bond over, but she can't help that it grates on her that William would engage with him willingly and still direct so much resistance and dismissal at her.

_George has even begun calling him Sherlock._

_____________

A week later, when William goes to the hall and picks up the dog lead, Violet hurries in.

"I'll join you," she tells him, going for her wellingtons.

It's been raining for days, which has turned the local public footpaths into sludge. Now, there's a cloud cover but no drizzle. To be on the safe side, they both pick wax coats. The dog is already fussing about their feet, nearly tripping Violet. William has done nothing to welcome her to participate in this walk, but at least he hasn't refused. She'll take what she can get. At least she can keep him from popping into the pub to buy cigarettes; she has suspected for weeks these dog walks are his perfect ruse for obtaining them. He tries to pretend he doesn't smoke, but she can smell it on him afterwards even when he manages to slip into the back garden unnoticed to indulge.

They walk quietly past the Snowdrop Inn, and William keeps giving her wary glances as though trying to work out why she's come. The dog occasionally lingers behind to sniff at something, but altogether it is walking in a decent manner next to him.

"Is he easy to train?" She asks to break the ice.

William shrugs. "I guess. The trainer said that it's probably the Labrador in him which makes him partial to treats, and that can be used for conditioning. Breeds that aren't interested in food can be more challenging to train. Standard poodles are incredibly intelligent and were bred as a retriever breed for water-fowl, whatever their image is today as a lap-dog. So trainable, yes."

"Makes sense. We never had pets in the family, didn't even know how to miss the experience."

"Dad's family had dogs."

"Yes, they did. I'm sorry you never got to meet your grandfather on his side; he was a formidable man. A bit old-fashioned in his ideas about women, though. Thought that sending them to university was rather a waste of time and money."

Thankfully, her own father had been of the opposite persuasion. They weren't a wealthy family, so he wanted his children to be able to support themselves. Violet has a sister and a brother she rarely sees; they're all busy with their lives and careers, and they've all done well. Lily-Ann's son is a lawyer, now — a fact she never neglects to mention during their phone calls. In return, Violet tells her about Mycroft's achievements.

"I thought we could hire you a new violin tutor. I'm sure there's someone available at a reasonable distance who instructs adults. I'm so glad you've kept playing; I'm sure there are still technical things you could advance with if we find the right instructor."

William shrugs.

Violet pushes on. "Have you had thoughts about what to do after the summer? Mr Hall's looking for an assistant at the pharmacy, that could be something. I had a word with him when I popped in for some plasters; he said that a former medical student could be a very good fit for the position."

"What? I don't want to work at a pharmacy, Mummy. It's so typical of you to just begin negotiating things on my behalf. A pharmacy assistant job sounds like a consolation prize for a dunce, which is exactly why you must have latched on to the possibility."

The accusation stings. Instead of a consolation prize, she had thought of it as a chance for him to use the knowledge base he has built at medical school. "But why not? You could find something part-time, locally, then maybe look at becoming a research assistant or something similar in the autumn? There are universities within commuting distance from here. I'm sure they'd take four years of a medical degree into account. Portsmouth and Southampton are a bit far, but there's the University of Sussex in Brighton. I know a few people at the Faculty of Economics; I'd be happy to call them and get some names of who you might talk to at the natural sciences departments."

"So, pharmacy work is plan A, and this is plan B, all decided by you and you alone. Why would I want to be a research assistant?" William's tone is incredulous.

"It would be so much less taxing than being a doctor."

"I'm not living here for the rest of my life."

"But you _are_ here now, and I'm sure you'll see, once a bit of time passes, that it's for the best. Why try to take on more than you can handle, bite off more than you can chew?" Violet schools a smile onto her features as they watch the dog gnawing on a broken branch, pulling tree bark off it.

"I need something to do, but not… any of _that_."

"Your father and I would, of course, be very supportive if you decided to just take a few years off. You've had enough schooling to get by. It's time to rest and recover, now."

"You make me sound like some Victorian maiden who gets sent to school only enough so that they won't appear too stupid for a potential husband." William slips the end loop of the lead around his wrist and shoves his hands into his coat pockets.

The dog finally stops taking apart the branch and agrees to walk along with them. Violet doesn't know why William hadn't just scolded it and pulled it along.

The subject of marriage is something Violet has avoided with him. She has talked to him about being safe and avoiding getting into compromising situations; she'd done more than enough lecturing to him about how great a danger he is in of being taken advantage of because he doesn't understand how to deal with people.

The topic of relationships, in general, is a more complex one. He's never shown any interest in girls. The only time Violet has ever suspected any romantic interest on his part was with that Victor. William had exploded at her when she'd asked if he'd been taken advantage of by the boy. He'd insisted that Victor was his _friend_ , after which Violet had reminded him that he had no understanding of such things, and making a distinction between that and an abusive relationship he'd best leave to others.

Not that William ever actively sought her advice with anything. _I suppose teen boys never want to discuss sex with their mothers_. _There is so much perplexing complexity, now, with young people's sexual and gender identities_. Violet knows that some identify as asexual, and she wouldn't be surprised if that was the case with her William. His interests have never been about people — that's why the idea of medical school had been so surprising. Of course, later on, she'd understood that his specific interest was neuroscience, which was intimately connected to other natural sciences and much more theoretical in nature than most clinical fields. What she doesn't get is his fascination with surgery — all that blood and mess and having to deal with patients and family members. He certainly has some skill with his hands and intellectual prowess — he'd been six when he'd taken apart George's alarm clock and put it back together. This is why Violet thinks that research and academia — part-time and with a sturdy support system — could provide him safely with the cerebral pastimes he requires.

"I'm not taking a year off anything," William declares as the public footpath takes them along the edge of a field growing feed for game birds.

The statement seems cryptic. _Is it because he no longer thinks he has anything to take time off of?_ Violet certainly hopes that is the case. They need to put Cambridge behind them.

"And I'm not living here in some fool's paradise under your thumb," William adds. It sounds like an accusation.

"You should focus more on yourself and what's good for you than uselessly blaming things on me that are not my fault," Violet tells him sternly. "You should talk to Mikey about the stresses of working life. I'm sure he has some good advice and a realistic perspective to offer."

William gives her a rare moment of direct eye contact. But, as usual, he does it only because he's stubborn. "Advice from _Mycroft_? As you are always the first to remind me, I'm not anything _like_ him, am I?"

"We all have nothing but your best interests at heart," Violet reminds him. "Rather than insisting on making your life difficult by making the worst choices every time, perhaps you could listen to people who have sturdy skills in leading an adult life."

 _Always so resentful. Always ruining everyone else's efforts to make his life better with his need to make a show of himself._ If only William had even just an ounce of insight, he'd see this vicious cycle. He keeps misdirecting his energy at opposing her when he should be trying to sort himself out.

 _I'm his mother. I should know what's best for him_.

**Notes for the Chapter:**

> Yes, Slugwash Lane is real. In fact, J once drew [drunken fanart](https://jbaillier.tumblr.com/post/620898046924980224/theres-a-slugwash-lane-in-haywards-heath-sussex) of it.
> 
> Don't forget to check out [J's Tumblr tag for Differential Diagnosis](https://jbaillier.tumblr.com/tagged/diffdg) containing moodboards for the chapters.


	19. Self-help

"How do you _really_ think he is?" Violet pleads with her older son once again.

Mycroft is planning to visit over the weekend, but Violet is desperate to hear his thoughts on her description of the past few days. She needs to prepare him for the worst.

"It really is hard to say, Mummy. He's not the easiest person to analyse, as you are well aware."

"Yes, yes, of course he isn't, but we all _know_ him, and it's good to hear your take." The fact that Mycroft hasn't spent all summer with William is an asset in Violet's opinion — it means he can see changes which elude those constantly present such as herself.

"What does Father think?" Mycroft asks.

"That he's more communicative; it's just that he mostly talks to the dog," Violet replies with more than a hint of distaste in his voice. She knows her Mikey will share her view that animals are hardly a substitute for human companionship. Her eldest has never been an animal person, and not just because he is allergic. "You know how William is; won't talk to me at all; he's always so strangely resentful. I so hope he grows out of such teenage petulance soon. Would have been unbecoming of a doctor; thank God that's all in the past, now."

"So he's not going back, is he?"

"Of course not!" Violet dismisses. "Why would you even ask that? He should have learned his lesson by now, considering what happens every time he tries to manage on his own. Why can't he understand that he needs looking after?"

"It's not something anyone would accept easily, especially not someone as stubborn as him," Mycroft says dryly.

He often says things Violet isn't keen to hear, but he's a very good sounding board and a voice of reason and Violet is so grateful to have such a sensible and responsible son. "We suggested that he might take Fibonacci to one of the local dog training clubs; that should get them out of the house, and we do need to teach him to behave properly on a lead, how to respond to commands and such."

"I assume you mean the dog?"

"Oh shush, you," Violet pretends to chide before laughing. She wouldn't accept such dark humour from anyone else. Mycroft appreciates how challenging it has been to help Sherlock adapt to society.

"What _will_ William do once the summer is over?"

"Perhaps a job? The local pharmacy is looking for part-time dispensary assistants; with his medical knowledge, William might be suited to that as long as it doesn't involve customer service." She isn't going to bury that idea just because he'd initially dismissed it.

"Is he still seeing the Burgess Hill people?"

"The care plan practitioner, yes. He sees her weekly. He's declined proper therapy, of course he has. Prefers to play his violin half the day, when he isn't fussing with the dog. Far be it from him to ever accept anything he needs in the way of proper medical help. How does he think that sits with this irrational idea of him becoming a doctor, I will never understand." Violet huffs. "Can't force him into therapy, can we? I wouldn't be surprised if he was flushing the antidepressants prescribed to him last week. It's as though he _wants_ to be like this."

"He's had quite a wobble, mother. One can't really speed up adjusting to one's changed circumstances."

"A wobble which could have been prevented if he's only listened to me. We're just going to have to be firmer with him from now on, don't we?"

"He's a legal adult, Mummy, so that might prove challenging."

"Surely, he sees now how he's been banging his head against a wall. He absolutely cannot be trusted to make sensible decisions about his life."

Violet slips her hand into her apron pocket — she'd been baking Irish soda bread when Mycroft had called — and pulls out the envelope which had been among the day's mail. Sherlock's name and the address of the cottage had been messily handwritten and there was no return address, so Violet had opened it. It couldn't have been from the university, so Violet had a hunch she should be aware of what it entailed. The worst-case scenario was that it was from that student who had bullied Sherlock. She certainly isn't going to let him upset her son any further even if the letter contains an an apology — William doesn't didn't understand those; not as a recipient or the one offering such a thing.

The letter turned out to be from that dreadful Trevor boy. She puts it on the kitchen island next to the flour bag while exchanging a few words with Mycroft about his recent promotion. After establishing when he'll need to be picked up from the train on Friday evening they ring off.

Before going back to her half-made dough, Violet picks up the envelope again. She'd skimmed the contents of the letter, and they had been precisely what she had expected. It began with a customary inquiry into how Sherlock was doing at university. Victor had found out that William — well, he kept calling him Sherlock — had gotten into Cambridge from some mutual boarding school acquaintance studying biochemistry there. Victor expressed disappointment at the termination of his and William's friendship, after which he apologetically asked if Sherlock could help him out with some financial trouble by taking some money to a contact in London. The letter is not neatly written, nor is it logical and coherent in content. The paper is cheap and requesting money after such a long alienation reeked of the boy prioritising his drug habit over friendship. _Deplorable_. Violet has a hunch that this mysterious financial hardship is connected to criminal activities. No sensible person would even respond to such an uncouth communique, but William just might be naive enough to do what his former friend wants. _No sense of self-preservation, and he wouldn't be able to read between the lines that_ _the Trevor boy only wants money, not friendship. I do so pity Victor's parents_. She'd never liked him, not from the very start, when he'd come down to Sussex with William that one time on a mid-term break.

Violet doesn't know anything about the mother but she's aware that the father is an MP. How many such letters have they received from their son? Perhaps he is writing to William because all other sources of funding have been cut off. Even if William might be happy knowing that his friend was still alive after years of hard drug use, nothing good would come out of that letter. William is in a dreadfully fragile state; being reminded of the Trevor boy and being lied to that Victor is still interested in being acquainted… who knows what William might do.

Not wanting to take any chances, Violet takes the letter to the sink, fetches the matches from the edge of the metallic stove cover and lights the envelope into flames.  
  
  


_________________

"Why don't you go get him? He's been playing for hours, now."

Annoyed by his mother's words which he can hear from the foot of the stairs through the door he's left open to his room, Sherlock lets the bow bite just a bit harder into the E string. _The composer's dead, he'll hardly mind._

Violet has been fussing all day about Mycroft's imminent arrival. She has reminded Sherlock several times that it's customary to come greet family when they arrive, to which he has responded that he doesn't think that should apply when one has had no role in inviting the person. So what if his brother has just arrived?

Sherlock doesn't _mind_ Mycroft's company, but he detests the way they are treated so differently by the same mother. While Sherlock can never manage to do anything the way she wants, Mycroft can do no wrong. When they were children and Mycroft turned out to show no aptitude for a new hobby chosen by their parents, he was allowed to quit and got reassured that he had plenty of talents in other things. In contrast, Sherlock was commanded to keep trying because it would teach him patience and important life skills. The violin was a good example. Thankfully, he actually enjoyed it. His tutor of eleven years had been a quiet, older woman by the name of Gloria Langdon who respected the fact that he didn't want to be touched and didn't expect verbal communication from him during lessons. She showed him what she expected, and he did his best to imitate the technique.

For the past week, he's been practicing Max Reger's third violin sonata, a piece Mrs Langdon had assigned him during his final year of lessons. He'd managed to polish the _Largo con grande espressione_ part to a good enough state that he'd plucked up the courage to play it to Victor on one of the very few occasions when he'd come to visit. Mostly, they spent time together at school or at Victor's house because Sherlock had wanted to expose his friend to his mother as little as he could. Violet had scrutinised his friend's behaviour and their friendship to death, try to micromanage it and given him unwanted advice.

He hadn't played very well that day for Victor. He'd been too anxious, felt too out of place in his own room just because someone he liked was suddenly there. Victor apologised that he wasn't into classical music and couldn't estimate at all how well someone played. He didn't understand that what mattered was that _Sherlock_ would always know whether he'd reached his own standards. It was the same with trying to engage with others; he could sometimes sense when he'd failed and didn't want to be placated for it. Violet had certainly never applauded his efforts unless they were a complete success.

He finishes stumbling through the _Allegro con moto_ which opens the piece just as Mycroft makes his way to the upstairs landing and puts his travel case down on the hall floor before stepping into Sherlock's room.

Without turning to face his brother, Sherlock starts loosening the bow hairs. "She's summoned you to lecture me, then."

"I do visit regularly; a habit you'd have done well to adopt."

 _Past tense_ , Sherlock notes.

Fib, who had been curled up on Sherlock's bed has woken up to the unfamiliar voice and nearly falls off the bed in his enthusiasm to stretch quickly and then scramble to greet the visitor. It has been amusing for Sherlock, watching the human-loving puppy endlessly attempt to gain Violet's attention and affection. Occasionally, he manages to get scratched behind the ears. How anyone could refuse the look Fib gives to humans when he thinks he's not had nearly enough attention or food, Sherlock has no idea.

He puts the violin in its case and turns to witness Mycroft eyeing the dog suspiciously. _Probably worries about getting hairs on his tweed trousers._ Ever since he first got exposed to the stuffy, entitled upper class boys at Eton, his brother has always dressed like them. The thirty-one-year-old has now shed the jacket matching his moss green herringbone trousers and revealed a white dress shirt underneath.

Mycroft does not extend his hand for the puppy to sniff even though Fib is wagging his tail almost frantically and staring up at him. "I'm allergic," he dryly explains half to the dog, half to remind Sherlock. "I've taken an antihistamine in preparation. Mother says a labradoodle's fur shouldn't bother me as much."

Sherlock had got sweaty during the exertion of playing and will soon get cold in just his long-sleeved grey T-shirt, so he quickly slips on a new, dark blue cardigan. Violet had dragged him to the shops yesterday, and they'd had a row over clothes. He'd insisted that if she really thought she needed to buy him something, it would have to be non-scratchy.

"How are you, William?" Mycroft asks courteously.

"Cutting straight to the point, are we? Haven't you been receiving regular reports from Mummy?"

"In all things, I prefer to assess the evidence for myself."

"And she gains a spy in the process. Serendipity."

Mycroft sits primly down in the desk chair. Fib plants his bottom right next to this new human's feet, tail whisking the beige carpet. "You shouldn't be so resentful towards people who are only trying to support you. I helped Father arrange for all your things to be packed up and taken into storage at Cambridge. We'll get them transported back here next week."

Sherlock had been informed of this. Their parents had hired some moving company, and his landlord had let them in. He resents the notion of people touching his things. There weren't that many of them left at the flat; all the important things had been packed up and dragged to Sussex along with him. In Violet's eyes he wasn't probably all that different from some old, ugly piece of furniture with a broken leg — something she keeps around for some misguided sense of duty and nostalgia but doesn't really like looking at.

"For all that it's worth, I am sorry for the way things have turned out," Mycroft comments.

"Such words aren't worth much to me, given you've been predicting such an outcome for years like the chorus in some Greek tragedy." _A tragedy in which the star is Mummy, not me_.

"I will help you in whatever way I can to find something you can do with your time," Mycroft promises solemnly.

Sherlock meets his gaze briefly as he kneels down to the dog and presses it gently against his chest. Fib gives his cheek a lick. "Then help me get out of here."

"Things are still precarious, given your… _episode_ ," Mycroft says. "You shouldn't make any important decisions in your state."

"In my _state_? You make me sound like a pregnant teenage girl. I bet they get told what to do as often as I. This isn't some _episode_ I'm having, Mycroft — I've been dragged away from Cambridge, because people think I can't manage."

"That's not how Mummy described the sequence of events."

"I don't give a damn what she said. She twists things to her liking."

"It is time for a careful re-think," Mycroft insists. "You did pass four years of undergraduate studies at Cambridge; you can cut your losses with dignity and find another path. Your efforts were valiant, and you got admirably far."

"Further than anyone expected, you mean." His brother's condescending approval makes Sherlock's stomach acids churn. Nothing but the calming haptic sensation of Fib's soft fur under and between his fingers keeps him from lashing out. "There's nothing else I want to do. If I can't finish my degree and practice, I might as well not do anything."

"We both know that idleness and boredom in your case may pose significant dangers for your sobriety and your mental health. Boredom always led to trouble as a child and being without direction pushed you into some very unsavoury company after sixth form. While I doubt that you'd find all that many suppliers of narcotics in these parts––"

 _Oh, you'd be surprised._ There are places close to the train stations where Sherlock could score if he so wished. Right now, his sobriety is mostly a desperate desire not to prove his mother and Mycroft right about why he uses and whether he'd resort to it again because of stress. However, the temptation does make him grit his teeth at night when he can't sleep because his memories won't leave him alone. All of it, everything that happened at Cambridge and what he has lost, keeps spinning in his head, entwining into a knot of regret, anger and anxiety.

"At times like these, it's very important to rely on the people who know you and care about you," Mycroft tells him sternly.

 _Pompous git._ "What do you know about _times like these_ , hmm?" Sherlock snaps and stands up. "What have you ever lost or failed at or been told to give up on? Whatever you did, especially if it was particularly normal and mediocre or disgustingly conforming, you got all the praise. Whatever _you_ told them _you_ wanted to do, Mummy and Father bent over backwards to make happen. You got _asked_ what you preferred, whereas they've always just assumed they know better what I want."

"You shouldn't make this Cambridge thing a fantasy of some imagined slights against you. Mummy says you insist on blaming some other student for all of it. That's not very mature or responsible."

Mycroft's sharp gaze sweeps the room, and his attention is caught by something on the shelf. He chuckles, then points at a model of a ship with a skull and crossbones painted on the sails. "Do you remember this?"

It's a phrase Sherlock has never understood. He knows it's an idiom, but… of course he remembers such things, how could he not — he sees the item all the time because he's the one who put it on the shelf all those years ago.

"It was your idea to make it a pirate ship," his older brother reminds him needlessly.

It had been Mycroft's school project for history — to build a model of an Age of Discovery ship. Sherlock had wanted to help and found materials in the woods which their father had helped turn into parts. Mycroft was not very keen on art or crafts, preferring to study history from books, so the project had ended up being mostly done by Sherlock.

"Mummy got angry when I got glue in my hair," Sherlock reminds his brother. A few locks of hair had to be clipped because of the stiff tangles just wouldn't unravel.

Mycroft briefly picks up the delicate, dusty ship, then puts it back on the shelf. "There are many things that could interest you, hobbies that could be a suitable low-stress, socially untaxing pastime. You just need to explore what's out there instead of stubbornly chasing one thing that is pie in the sky. You gave medicine five years; isn't it time to move forward?"

"Living at home and working part-time at the local pharmacy doesn't sound like moving forward, no matter how you try to dress it up.."

Mycroft purses his lips. "I suppose it doesn't. But you need to get well first. Give it time, Sherlock, and stop blaming others for what you can't change." He grabs his jacket from the shelf onto which he'd arranged it and straightens his trousers. "I believe Mummy has some rhubarb crumble ready any minute, and she asked to inform you there's ice cream as an accompaniment."

"Speaking of what _you_ are interested in," Sherlock teases bitterly..

Fib darts out of the room and down the stairs; the clatter which has just sounded in the kitchen is probably an oven pan but sounds a bit like the tin in which the dry dog food is kept.

"Food never failed to improve on a bad mood," Mycroft says. "I need to go unpack before tea."

 _It'll take a lot more than food to improve my mood in this bloody house_ , Sherlock thinks as he reluctantly makes his way downstairs. Now that Mycroft has come to visit for the weekend, Violet will undoubtedly recruit him in her campaign to, quote, ' _make_ _William see sense_ ' as he'd overheard her say to Father only yesterday.

  
_____________  
  
  


It's not really a relief when Mycroft leaves two days later, even though it may mean fewer conversations with several people lecturing at Sherlock. Mummy showering her firstborn with adoring attention means she's not been focused on her youngest, even if every word of praise feels like salt in his own wounds. George prefers to stay out of difficult conversations. If he could sometimes, just _sometimes_ take Sherlock's side, things would be easier, but he never does that unless it's just the two of them talking.

When he gets back from walking Fib at sunset on Sunday evening, there are two letters on Sherlock's desk. He sits down on his bed to read. One of them is from the educational secretary, and it contains his exam results.

The result sheet shows that he has passed both the general practice exam and all the parts of the psychiatry course. _All_ of it.

He stares at the printout in disbelief, then continues on to the final pages. First, there are copied general instructions regarding the next term, but more importantly, the final page is a letter informing him that he has been granted his first choice for an applied clinical practice surgical placement for his final year — neurosurgery. He has also had luck with the acute care placement — they've given him a spot at the neurological service. His third senior rotation will be cardiology — mostly useless but more interesting than many of the other conservative fields. His GP rotation placement is… _Who cares,_ he thinks. _They gave me a spot in neurosurgery!_

After a momentary elation, his spirits deflate. Does this change anything? His name is on a list, that's all. It's not in any way connected to what's going on to what happening with Wilkes, any and all of which could derail these offers completely.

The other letter, however, has _everything_ to do with those things. Sherlock has been expecting a letter from his academic supervisor to confirm their progress meeting. The second letter does contain that date, but there is also a personal note which refers to " _the incident with Sebastian Wilkes_ ".

The letter from Professor Benington states that Wilkes has been placed on rustication — an archaic term still used at Cambridge to denote temporary suspension — and is facing _bannimus_ , permanent expulsion. The Professor predicts that, once the appropriate faculty board has convened in September, a public announcement will be made regarding Wilkes being kicked out of both his college and subsequently the medical programme. Sherlock is being asked not to relay this information to anyone until an official announcement has been made, ' _as there are other parties involved; yours was not the only case_ '.

Benington goes on to explain that there had been a complaint of sexual harassment from a female student the year before, and Wilkes' attitudes towards patients has raised eyebrows among staff, as well as his obviously drinking-related absenteeism.

Sherlock's shaking hand, holding the letter in a vice-like grip, drops onto the bed.

_Sebastian Wilkes won't ever be a doctor._

The enormity of the news sinks in slowly as Sherlock realises what this means by extension. He's passed his exams and has been assigned final year rotations. He has a meeting with his academic supervisor, and the letter hadn't mentioned anything about probationary action towards Sherlock. He's not being strung up by the college because he hadn't disclosed things he wanted to keep private — at least not yet. He suspects Benington will take up the matter in his progress meeting. _There's still that horrible evaluation they made me undergo._

But, even with that hanging over him, he can't help feeling like a weight has been lifted off his shoulder. A weight that has been sitting there, breaking his spirit, joining all the criticism he's had to endure ever since he has been able to form memories of having to deal with other people.

_Wilkes was the one who did wrong. Wilkes is the one they think is unfit to be a physician. Not me._

They're not all against Sherlock. They're not using this as an excuse to push him out. Not _yet_.

This changes _everything_. He has a chance.

_________________  
  
  


"He's been chewing on that lead again; we'll need a new one soon," George muses with fond amusement at Fib who's stuck his nose into a hedge after seeing some bird disappear into it.

Sherlock is clutching the leather lead with both hands; not because he worries Fib will run off but because he needs something to which he can divert his anxiety. His Dad had taken his side with the dog once, and now he needs an ally again. Mycroft, let alone their Mum, cannot be expected to support his decision, and their new furry family member will now be a major complication in it. He can only hope that his father has grown to like Fib enough that he will keep the dog, because his schedules during the final year would never allow for looking after a canine. Sherlock doesn't have anyone he could ask for the necessary help when he spends long days at the hospital, and the guilt over the dog having long, lonely days without exercise or company would be crushing. Besides, King's College dorms don't allow pets, and if he's to go back he knows Violet Holmes wouldn't hear of him living outside the college. The way in which his last residency in a private flat had ended would be an argument hard to counter, so he'll pick his battles and give in to her when it comes to his living arrangements.

"Cat got your tongue?" George asks playfully. "Don't mind it if you're not in the mood to talk, of course."

Fib shakes his wavy fur after it has been messed up by the hedge and heads down the path again, eager to find new smells. He's much better at staying on the walker's side, now, after lots of practice and training according to instructions they'd got from the local kennel club's puppy class. George has driven Sherlock and Fib there eight times, now, after they'd both agreed that getting the dog well-trained is key to Violet tolerating it in the house.

The words burst out of him when the constriction of anxiety around his chest gets too much. "I'm going back to Cambridge."

"Oh. I thought you'd decided not to return."

His father's mild reaction gives him some encouragement, whilst at the same time annoying him because he knows where his father will have heard that 'decision'.

"Let me guess who told you that I'd made up my mind," Sherlock replies, gritting his teeth. "She thinks she's decided _for_ me, but she can't. I won't let her. I'll be taking my things back to King's."

"Was it the letters that make you re-think it? Violet said there were two of them from the university."

"Yes." Sherlock adds, "I'm surprised Mummy didn't steam them open and throw them away after reading."

In his peripheral vision, Sherlock sees a wry smile form on his father's lips as George replies, "I told her that if she did, I would tell you."

"Then I am surprised that she didn't stand over me when I opened them, demanding to know what was in them."

"Give her some credit, son. She was worried that if it wasn't good news then you might take it badly, that it would upset you just as things were settling down. I'm not sure she will be happy with your decision about returning."

 _Understatement of the century._ Sherlock 's father will listen and not dismiss him immediately like Mummy does, but he's just not accustomed to going against their wishes and weathering the outcome, and he doubts George would be willing to try to turn the matriarch's head. Sherlock hates being so alone in this, hates the fallout of having to listen to his mother's complaints and predictions of failure. It has always been easier just to roll with the punches when it comes to Violet Holmes, but this is one issue in which he can't let her win. _I can't let her take this away from me. If I give in now, I'll never get out of here. I am an ADULT. If I fail, I'll fail giving it a proper try, instead of being too cowardly to tell her I can't stay here forever_.

"It was good news, then, in the letters?" His father asks.

"I passed my psychiatry course, including the practicals, and I passed my obstetrics module. Dad, they gave me what I wanted: neurosurgery for my final year!"

George's smile returns but his tone of voice is reserved, still. "That's good, so long as it doesn't turn out to be a poisoned chalice. I do think it would be a bit of a waste if you never got to add that degree to your CV."

 _What an odd choice of words._ "What do you mean?"

"Well, as you know, I was in academia like you mother, but once I got the patent and my business took off, I realised I was much better suited to this different life. Never quite found much work satisfaction in publishing papers and climbing the university career ladder like your mother does. I like getting to decide things for myself, creating my own schedules. Routines and strict rules were important for you, that's what they told us, but you don't really enjoy them, do you?"

Sherlock's brows knit together. _Where is this going?_

"A medical degree is very valuable. You could probably find some kind of a consulting position, maybe in the pharmaceutical industry? You could probably even do it part-time."

"I don't want a medical degree just so I could be something else than a doctor!" Sherlock protests.

"But why would you, of all people, want to work with patients?" George asks.

Sherlock realises he should have known that Violet _has_ poisoned the entire well by now. No one in the family will ever believe he is cut out for this. If he's to go back to Cambridge, he needs to do this truly alone, and not let anyone shake his beliefs.

 _If I fail, I'll do so on my own terms. And I won't. Not after everything I've already made it through._ He's pushed through areas of clinical medicine in which he's felt like the village idiot, and he's managed to pass those courses. Wilkes may be academically good enough to pass, too, and nauseatingly _normal_ in the way he can understand people, but that didn't save him when he turned out to be a bully with destructive attitudes towards patients and other students.

"I want to be a doctor because patients have intracranial tumours and cerebral aneurysms and problems of cerebrospinal fluid circulation and arterio-venous malformations and all those things inside living humans are much more interesting than cell cultures and research papers! I want to be the one to work out how to fix those people, and to get to do it with my own hands."

He says all this with more conviction than he's felt all year and is surprised at the ease with which he summons this confidence. "I want to solve those puzzles, Dad — solve how to cure those cases, how to match the perfect surgical technique to what I see in symptoms and clinical examination findings and imaging results. I want to be better at it than anyone — so good that it doesn't even matter if I'm less talented at some of the… other stuff involved."

His words ring thin in his ears. How could he even begin to explain the genius complexity, the poetic beauty of the human brain? In neurosurgery, symptoms connect to anatomy and physiology, there's a psyche to soma connection that has so eluded him in the psychiatry course. Why would he settle for anything less than solving the mysteries, fixing the faults of the most complex computer in the world, one made of flesh and blood? All neurologists do is diagnose; what he could as a surgeon do is repair, divert, reroute, remove — his hands against the ticking timebomb of an aneurysm or the growing parasite of a brain tumour. _How could anyone want to pick some other profession or medical specialty?_

"Do you remember that interview we saw of that surgeon, Mr Marsh?" George asks.

Sherlock does remember. It had been at Christmastime. The TV had been showing some all-evening charity special, and in one insert, they interviewed staff at an NHS hospital, including a well-known neurosurgeon by the name of Henry Marsh.

"Quite an abrasive chap, he was. Must be a challenge to work with, but a great surgeon," George muses pointedly.

They stop to exchange a few words with an elderly couple walking their golden retriever named Zeno. Fib seems to like the old, friendly dog. George seems to know the couple; Sherlock only nods in greeting because he's preoccupied with trying to understand why his Dad had brought up that old TV programme. Mr Marsh doesn't mince his words when it comes to criticizing NHS bureaucracy and other nonsense surgeons are forced to waste their time with instead of being in the OR when he gets interviewed in newspapers. Sherlock appreciates such candour. He'd leafed through Marsh's memoirs at a Cambridge book shop once, and the surgeon had recounted stories of conflicts with colleagues and occasional difficulties in getting along with other staff.

Once it's just the three of them again heading down the bramble-lined path, Sherlock speaks up. "Will you help with Mum? She'll never say yes to continuing my studies, not that it's her decision anymore. As far as she's concerned, I messed up badly enough that any talk of going back she'd just dismiss as me being… me. I know the university grant's in my name and legally, she can't really keep me from going, but in practice––"

"I know," George confirms. "I'm not sorry you've inherited your mother's wilfulness, and I suspect a bit of that is what every medical student needs. But that does make it hard for you and her to be on the same page. She's made sacrifices for you and doesn't want to see you come to harm. I don't want to see that, either, nor does your brother."

"That's what everyone keeps telling me. That you want to protect me. From what? _Me?_ "

"Your mother doesn't want to see you make the wrong choices, when other choices could have given you a much better, easier life."

"I don't want an easier life! I want _this_ life, because _I_ chose it, not her!" He knows he's shouting, and it drives a few small wild partridges into flight from the field they're walking past. Fib pulls on the lead, wanting to dart after them.

George stops, hands in his wax coat pockets. "I can't have that conversation with her in your stead, and it's one that you need to have at some point. I will talk to her as well but be prepared that she won't change her mind."

"Of course, she won't," Sherlock scoffs and they continue walking. The dog is pulling a bit because he'd prefer to run into the field to catch the birds where they have landed. "And she'll probably get rid of Fib just to spite me."

" _Sherlock_."

The name still startles him when it comes out of his father's mouth. He's the only one in the family willing to use it. Mycroft has sounded it out a few times but always looks like he's only barely keeping himself from making a face.

 _You're not a William,_ Victor had told him once when they'd sat on the grass in Hampstead Heath. _Williams are boring. You're clearly much more of a Sherlock. A Sherlock wouldn't get lost in a crowd even if he tried_.

He just has to accept that. Embrace it. Be better than anyone at the things he's good at, because there are things in which he just can't improve his skills much. He needs to become the surgeon people describe just as his Dad just had: as someone whose personality is, perhaps, not the epitome of a traditionally empathetic physician, but who is the absolutely best at their chosen specialty.

"Your mother cares about you," George tells him sternly. "Don't you forget that."

"She has a funny way of showing it."

"Our family — I mean my parents — decided they could only afford to send one son to university. That changed my brother's plans of studying law. There was a lot of resentment; you know we still don't get along very well, though I wasn't my decision. I don't want that between you and Mikey. And I don't want you to feel like someone else's decision meant that you had to give up on what you are convinced you want to do."

Sherlock knows he should be relieved that his Dad seems to understand, but that's only one step in a very likely futile attempt to convince his Mum as well.

He watches Fib having a smell of some flowers and then have a sneeze. He goes down on his haunches to give the dog a pat, which he eagerly accepts with a lick to his wrist. He feels acutely guilty of the upheaval he's caused in the dog's life and the fact that he's about to cause more of it. This is a much better home for Fib than the dog's first, but who knows where he'll end up, next? Sherlock is certain that Violet is unlikely to let Fib stay if he leaves for Cambridge. There are thousands of animals in shelters, aren't there? He's not a small puppy anymore; it makes Fib less likely to be adopted.

"When I go back, I don't want him to go to some rescue shelter," Sherlock says, not wanting to stand up because he's having to swipe at his eyes at the sudden onslaught of misery. It had been a spur-of-the-moment decision, taking the dog, and undoubtedly that is something his mother will throw in his face to point out how irresponsible and incapable of rationality he is. He leans down to stroke the black dog's fur, wanting to conceal his face from his father.

"Tell me why the dog has meant so much to you," George prompts. "Maybe there's a point to be made there."

"He doesn't judge. He has no expectations, doesn't demand I be anyone other than who I am," Sherlock explains quietly. "It is easy to understand what he is feeling; there are no social rules that confuse me. He accepted me at a time when I could hardly accept myself. For that I owe him a great deal. The people who had him before abandoned him long before they gave him to us. I don't want that to happen again." His voice shakes a little.

"He's not going to a shelter," George says amicably. "We don't send family away, do we? Not unless they want to go to medical school in Cambridge," he adds with soft humour. "Without you around, I'll bet he ends up being called Natch, though, rather than Fib."

That makes Sherlock let out a soft chuckle; the family had been unable to agree on how to shorten Fibonacci into something quicker to use when calling him back. His father had not taken a stand one way of the other.

George reaches out for the lead, and Sherlock passes it to him, rising to his feet.

"He'll stay right here," George promises again. "Your mother may not accept you returning for your final year, but I'll make sure she accepts sticking to a decision already made together, which is that we now have a dog. Lord knows I need the exercise; was getting a bit lazy about that in the past few years. Fib is old enough now to be able to cope with the occasional days when both your mother and I are away at work, and we can always find someone in the village on those days to give him a walk. He's becoming quite popular; maybe the Grants will walk him with their Zeno." He bends down to release the catch on the dog's collar; they're in a fenced field, now, where Fib can be allowed to roam free.

They finish their walk in an amicable silence. The anxiety Sherlock has felt for days feels marginally lifting as he watches Fib darting about, still full of energy. The landscape in the lands surrounding the village is just perfect for a dog.

Once back at the cottage, he takes care in wiping the dog's paws just inside the front door with an old towel designated for just that; his mother hates getting mud and sand on the carpets. She's watching television in the sitting room, and George has already joined her there.

"Don't let her tell you what to do too often," Sherlock whispers to Fib in the hall, nodding towards the sound of the BBC News. "She's already convinced enough that she gets to run everyone else's life."


	20. Are You Sure?

Violet Holmes has been sulking for almost a week. On the one hand, Sherlock welcomes the fact that she isn't bothering him as he makes the final arrangements to return to Cambridge. For the first three days after he'd told her, he'd spent most of the time in his room to avoid confrontation, playing his violin, escaping only to walk Fib and sneak the occasional cigarette.

He's decided to go up early, citing his progress review with his Director of Studies as the reason for going two weeks before term starts. To be honest, he just wants to escape the atmosphere in the cottage. More than once, he's overheard raised voices in the kitchen — his mother arguing with his father. Tonight, yet another one of those arguments has driven him from the house on a long walk with Fib. His mother has to even disagree on what to call the dog — she seems to have settled on Natch. _What is it with her and names?_

Last night, Violet had — once again — tried to change his mind about continuing his studies. He'd inadvertently offered her that chance by lingering in the kitchen after dinner because he'd wanted an extra portion of dessert to make up for the fact that he'd barely touched his dinner, full of it as it was of tastes and textures he loathed. Couldn't she make her beloved Waldorf salad when he wasn't at home? Somehow, he doubts that other twentysomethings remained the object of a parent's campaign to get them to _'at least have a taste of everything that's on offer to be polite_ '. He _knows_ what he can bear to eat, and what he cannot get down his throat. Celery is a taste and texture so offensive that it makes his eyes water.

Sherlock had tried to excuse himself for a walk with the dog when she pounced on him in the kitchen last night, but George had trapped him by saying he was taking Fib out for a walk on the Common. "I'll do it, so you can talk with your Mum for a bit before you leave," he'd prompted gently. He must have known it was the last thing Sherlock wanted, but he has kept insisting that mother and son need to talk things through. _As if she'd even listen. She lectures at me while I try to get her to register and accept a single word I say._ Defeated by the two-against one last night, he'd settled into the chair furthest away from the kitchen island which Violet was furiously scrubbing clean. For once, he had no trouble interpreting the expression on her face. She was both angry and frustrated.

"I don't understand _why_. Why is this so important to you?" She demanded.

He had bit back his first thought, which was to shout at her: ' _Because I want to go back, I don't owe you any further explanation, and you can't stop me_ '. That would only have fuelled her draconian fury.

He had settled for statement so calm that it surprised even him: "This is something I have worked for over years. I've passed all the fifth-year courses, so there is no reason to stop now."

"And you don't think what happened at the end of last term isn’t cause enough? When we got to Cambridge you were a mess, William. The flat was a cesspit, you'd not bothered to tell your internship lab where you were — hardly in a fit state, unable to talk, to eat or look after yourself properly. The stress and strain of the term had reduced you to… well, I don't know how to describe it even. The idea of you going back to that again is just absurd."

"You might not know how to describe it, but oddly enough, I do, after the Psych and Mental Health Unit and Burgess Hill. I was _anxious_ and most important, I was _depressed_ , mother; depressed because I thought I had failed a course which might mean I wouldn't get a neurosurgical final year placement, anxious because I didn't know what would come out of trying to make sure that other student got punished for what he did. With hindsight, I ticked just about every box on every symptom of the diagnosis. Anyone can get depressed if they're pushed too far." _It's not just me. It's not just because I am what you hate even saying out loud._

"Then why wouldn't you agree to take antidepressants? We sent you off to that dreadfully expensive clinic for three weeks, and you still didn't take any medication they prescribed."

"Because I don't need drugs; you're the one who told me that."

Violet's eyes narrowed. "Those were illegal drugs. I'm talking about properly prescribed medicine."

Sherlock wouldn't look her in the eye. "Both are psychoactive chemicals, mother. _You_ told the staff that I don't tend to react to such medications in a _normal_ way. The solution to my depression wasn't a pharmacological one. Removing the cause was."

"What about therapy, then?"

"I've had enough of that to last a lifetime, thanks." He gave Violet a glare.

She'd crossed her arms. "Then what has worked? What has really changed? You're going back into that hellish environment no better prepared than you were before. How many times do you expect us to keep rescuing you when you come apart at the seams?"

"What is different is that I did not failed the course, and that Wilkes paid the price of his horrible lies. I'm not the one who doesn't deserve a place in the programme — _he is_. And let's add to that the fact that the medical school has agreed to let me take neurosurgery as one of my final year rotations. It's incredibly competitive to get in, but _I did._ So, those facts were — _are_ — the best cure imaginable. I made it this far."

She stopped clearing the kitchen island of dirty dishes. "Until the next crisis, then. What's to say the same thing won't happen again? If it's all so competitive, what if some other student decides to pick on you because you are different?"

Sherlock had finally lost it. "Don't you idiots _see?!_ Wilkes was wrong, not me!"

"I am not an idiot, William. Mind your manners. He committed academic fraud, but that does not change the fact of why you let the relationship break down so badly between you that he chose to attack you that way. It is symptomatic, why you've been having such difficulties with the other students and the teaching staff. Call it depression or what you will — hiding behind such words is just trying to pretend this isn't about the fact that you can't deal with people. This dreadful thing with that other student happened because your issues with other people undermine everything you are trying to achieve with your studies. I don't think you have the slightest bit of self-awareness when it comes to making sure we never have to find you like that again. It's not just about you — your father and I can't just drop everything and come to your rescue every time there's a problem! How do you think _I_ feel when I have to watch you suffer like that? Mark my words, it will never be worth it."

"You can't decide that for me! That's your version of events, not mine, and _I never asked you to interfere!_ You're always so quick to blame everything on the fact that there is something wrong with me. Well, there isn't. Different doesn't mean _wrong._ That's what I've learned."

Violet stared at him. "It's like talking to a brick wall with you. I must say I'm disappointed in the Burgess Hill staff if _that's_ what they got you to think. Slap a plaster on, ignore the real problem. You must have run circles around them, rejected all their proper help just because you don't like accepting the truth."

At that point he'd marched out of the kitchen.

When Sherlock had returned, closing the front door quietly after him and the equally wary Fib, he'd discovered that his mother has retreated to bed in a huff, leaving George watching television in the sitting room.

He slumped down into an armchair; Fib pads to the warm spot in front of the fireplace.

"Nippy outside? You've a healthy colour on your cheeks," George commented.

"Not as chilly as in here. Mummy's gone to bed in a huff, I presume?"

George gave him a tight smile. "Give her time. There are many reasons why watching the two of you grow up and leave home has been difficult for her."

"I don't remember her worrying about Mycroft going away; it was never _difficult for her_." His tone was more biting than he'd intended.

"She worried less about Mikey, yes," George confirmed. He then looked thoughtful. "It was best you didn't know what it was like here after we sent you to Harrow. You weren't the only one needing a lengthy adjustment period. Your mother thought we'd made the wrong decision and blamed me for it."

"Blamed _you_? She always thinks that when bad things happen to someone, it's got to be their own fault and she's not even sorry because all she wants to say is _'I told you so'_."

"She's always demanded a lot from you. Maybe one day, you might understand her reasons."

 _Demanded from me, yes, while expecting me to fail. Encouraged and expected success from Mycroft. That's an important difference but nobody in this bloody house will admit that._ "Understand her and what, then? Forgive her for being such a––"

" _Sherlock_ ," his father interrupted. "If we want someone's respect and attention, we must be respectful towards them in exchange."

Sherlock scoffed. Wilkes had certainly never respected him, and no amount of grovelling or making nice would have changed that. He's tired of turning the other cheek and listening to his mother's incessant declarations that when he gets into conflicts, the other party is always blameless.

George shut off the tv but does not rise from the sofa. Sherlock shifted in the armchair so that his legs dangle off one arm support, his head from the other.

"Are you sure you want to do this?" George asked. "To go back. If your mother is right in one thing, it's that very little will have changed even if that troublesome student has been expelled."

Sherlock closed his eyes, his mouth an angry line. "Things _have_ changed, and that's what she refuses to accept. I'm not operating on some illusion that the final year will be any easier than any of the five I've been through, but it will be different. I need to stop caring about the other students, stop paying attention to what they think and stop expecting their acceptance. I _know_ now that the worst course of all is over, and somehow, I got through it. I got through despite all of Mummy's assumptions."

"You shouldn't go back just because of your mother."

Sherlock dropped his feet off the armrest and sat up. "I'm _not_. I was the one who sorted out the problem with that other student, not her. I got through the psychiatry course, no thanks to her. I didn't apply to medical school because of, or in spite of her, so going back there has just as little to do with what she thinks. It's not all about her."  
  


____________________________

  
  
Unsurprisingly, Violet Holmes doesn't relent her campaign of emotional blackmail and bad moods: breakfast today, the day Sherlock is due to leave, is a passively-aggressive silent affair. George has gone to work today in the London office, leaving at the crack of dawn to avoid the commuter crush.

Sherlock can hardly eat, and his mother's nerves are showing, too, because she burns the toast. After forcing down an egg and two slices of bacon, he scrambles away from the table and goes to take one last walk with Fib before beating a hasty retreat upstairs to finish his packing.

At half-past eleven she comes into his bedroom, announcing: "I don't understand why you are going back early. There won't be anyone else in that new dorm. Why today?"

The one compromise he'd agreed to is to return to college accommodation. New Garden Hostel is the newest King's dorm block — a modern building with single, en suite rooms and shared kitchen facilities. It is across the Cam River from the main King's campus, and quieter.

"I told you before; I'm going to revise some things, and attend my progress meeting, which is next week. It's something that every student coming up for the fifth year has to do. The medical school has no reason not to let me advance, but I want to hear more about my results than what was in the letters. I'm going back to Cambridge today, and that's non-negotiable."

"I should be in that meeting. Someone there should be attending with at least an ounce of realism." She grabs a cardigan which has been tossed on the bed and folds it neatly before sighing. "Why on earth would you put yourself through all this misery and stress, and make us worry ourselves to death on your behalf? You've had such a difficult time, and so many people have told you this thing with medical school was a mistake right from the start––"

Sherlock slams his suitcase closed, putting his violin case on top. "How many mistakes would one of those _normal_ _children_ you so idolise be allowed? How many missteps, how many _difficult times_ would be acceptable before they got told that they should just sit at home and condemn themselves to a life of ease and idleness? Five mistakes? Ten? Twenty? Wouldn't you tell a _normal child_ to try again, to assure them they just need more practice and support and for other people to believe in their abilities? Why don't I ever get that kind of help from you? If Mycroft had ever failed an exam, would you have told him to quit and become a shop assistant because _clearly––_ " his tone rises up in pitch in the exaggerated sarcasm, "–– _so obviously he's not cut out for anything he doesn't breeze through_."

"But William, clearly you can't––"

" _Shut up_!" Sherlock snarls, and he relishes for a moment the look of shock and surprise on her face. "I've heard your opinion, and I don't need the fortieth repeat. And you are sure as hell _not_ coming to Cambridge to stick your nose into _my_ business."

"No need to be rude. Perhaps it is too much to expect you to be grateful for all the help and support we've given you this summer, but you shouting at me is ill-mannered. This goes to prove exactly what I was saying — this whole business gets you stressed and angry to the point where you lose control and forget how to behave."

He rolls his eyes to the ceiling, and then closes them. _Give me strength…_

In a calmer tone, he continues, "For once in your life, stop doling out advice, micromanaging me, telling me I will never be good enough to reach any of your standards! I no longer run my life by what you expect. I'm not doing this for you, or for Dad or Mycroft, or to prove anything to anyone except me. I'm doing this for _me_ , and me only! I'm doing it because I want to do it, because _I need to see if I can_. If I don't see this to the end, I'll forever regret it. And I won't let you change my mind, Mummy. _I'm not asking for permission_."

Violet follows him as he drags the suitcase down the stairs to the front hall and begins putting on his shoes.

"I need a lift to the train station," he says forcefully.

"You haven't said a proper goodbye to your father. You might listen to him, if you won't listen to me."

"It's not a case of listening, Mummy, and he's far better than you at it. You have been talking at me, nagging and lecturing and driving me barmy all summer, and I've had enough. You think that sort of thing helps? _You_ stressed me out when you dragged me home, worse than Cambridge ever did. I am going back. Dad can always phone me. Are you going to drive me, or do I have to call a taxi?!"

She looks at her watch. "If we leave now, you'd be waiting there on the platform for an hour. Can't we just sit down and talk about this?"

"I've _sat down_ all summer and wasted precious time. There's nothing to talk about. All you'll do is talk down to me, patronise me and tell me that you know what is best for me." Sherlock loops a scarf around his neck.

Violet grabs the end of it. "Just… listen for just a second. While you're still a student, you are guided and protected––"

Sherlock scoffs loudly while she starts tying the scarf for him. "There is precious little of that on offer at medical school," he points out.

"You know what I mean, dear. And it is bad enough, as you say. But what happens when you graduate? You'll have to fend for yourself; you won't have the excuse of being a medical student anymore. Things will be expected of you, expected by staff and patients and their family members and your supervisors."

Sherlock tugs the scarf away from her and dons his short, moss green woollen coat. "I'll manage. If the likes of _you_ can do it, to deal with people, so can I." He slings the strap of the violin case on his shoulder.

"What on earth do you mean? I am an academic with a successful career; you and I are hardly comparable. You could find something similar to suit your career needs, too. I would never have attempted to be a doctor," Violet replies.

"And thank God for that because nobody wants your advice and you get nauseous at the sight of blood. Get your coat on."

"I'll take you to lunch so you won't have to idle away your time on the platform."

"I am not hungry, and I want to leave now. "

"Declaring that you'll somehow manage is not an answer to my question. How will you do that?"

"I'll learn. There's stuff doctors say that people expect. _'Oh, Mrs Mayberry, I am so sorry to tell you it's breast cancer; my condolences, here is a leaflet about our peer support groups_ ', he demonstrates in a slightly higher pitch. "I'll _learn_ , mother."

Finally looking somewhat defeated, Violet takes the car keys from the bowl on the telephone table. "It's not quite as simple as saying the right words, if you make them sound cold and rehearsed. Perhaps you could learn about some of these things, but who is going to teach you how to say them in a way that sounds like you mean them?"

He turns back to her and says in a low voice. "I'm not going to be a GP or a psychiatrist. What people will come to me for is surgery, neurosurgery to be precise. That does not need social scripts, mother. It needs a cool head and calm, technical skill — which I have in abundance. So you can drop the last ditch efforts to convince me otherwise. Go get the car."

It suddenly registers to Sherlock that Fib is sitting in the hall, watching the two of them, his head moving from one to the other as they speak. His ears are down, and he looks troubled by the tone of their voices. Impulsively, Sherlock puts his suitcase down and walks back to the puppy-turned-teenager, squatting down in front of him to rub his ears gently. The dog leans into his touch.

As his mother leaves the house, the front door slams and Sherlock feels the dog flinch at the noise.

"It's okay, I'm not cross with you. You've been the best part of this summer. I wish I could take you to Cambridge with me, but it's best if you stay here. You'll get lots of walks with Dad and I'll be back at Christmas. Sorry about the quality of the company, little I can do about that."

When Sherlock stands up and turns away, the puppy whines and starts to follow. "No. Sit… and stay."

Reluctantly, Fibonacci follows the instructions.

As Sherlock closes the front door behind him, he realises that the dog is the only one in the family who actually listens to him and does what he wants, maybe even the only one who will miss him, because Fib is a friend he chose, not a family member he got stuck with at birth. _There's a lesson in that.  
  
_

________________________  
  
  


Sherlock surprises himself by being much less nervous to see his Educational Supervisor than he would have expected. Perhaps listening to his mother complain about the man's refusal to cede to her demands for information had done it. Sherlock is hardly Professor Benington's greatest fan, but it appears that the old fool's habit of trying to avoid really engaging with his students or getting involved in any difficult issues had at least discouraged Violet Holmes. That is quite the feat.

Still, Sherlock has never wanted Benington's attention or support, least of all now. _One year left_. If anything, he needs to shake off the scrutiny of people such as his Academic Supervisor.

As customary, he wears a suit he'd had dry-cleaned — a black one with a white dress shirt. Simple. Conservative. All part of the disguise.

Benington puts his glasses on when his secretary escorts Sherlock in.

"Ah, Mister Holmes. Take a seat."

Sherlock spots his name on the thin stack of papers in front of the professor. One of the sheets is an excerpt from his student records listing his grades from year five. The rest, he has a hunch, might have to do with Wilkes.

"How was your summer?" Benington asks, leaning back in the creaky, old, leather-lined chair.

"I got all the revision done which I was planning," Sherlock says. "I'm ready to start the term."

The professor leafs aimlessly through the papers. "You didn't attend your summer internship."

"It's not a required module in my training."

"Yes, but when we last spoke, I believe you said that it would serve you well in planning an academic path to complement your specialty training plan."

"I had some health issues which prevented me from attending. Regrettably, the speed and manner at which they developed prevented me from informing the lab supervisor."

Benington leans forward. "Health issues? Are these still ongoing? Your mother mentioned nothing of this when she called me."

"No, and the topic is irrelevant to the coming term. With my family's help…" he adds, trying not to project irritation at needing to make such a statement, "…I've sorted those issues out."

"Good, good, glad to hear it." Benington skims through his record print. "Your grades remain as exemplary as ever, but some of the written assessments from clinical rotations are a contrast to that — particularly the Psych and Mental Health course."

"I allowed the issues with Sebastian Wilkes to affect my conduct. That will not happen again."

"Oh? What if someone else you don't get along with shows up in the future? What will you do, then?"

"Getting along is quite different to being blackmailed, humiliated and subjected to a criminal breach of confidence."

"Yes, yes, of course it is. But you know that neurosurgery is the most competitive of all the surgical specialties. It could be very, very pressured. Are you really up to that?"

"I've managed so far. What happened with Wilkes was the exception to the rule."

"Have you? Truly managed?"

Sherlock crosses his arms. "At least I've not been expelled because of gross misconduct and sexual harassment of other students."

"We're here to discuss you, not Mister Wilkes. The events of this term aside, the assessments from your various attachment clinicians are not as reassuring as I would have hoped. As _you_ would have hoped, I'm sure. The issue of your communication… challenges should have been addressed by the functional assessment we agreed upon, but I've not received a detailed report."

He hasn't, and neither has the Dean of Studies, because Sherlock had called the Disability Resource Centre and told them to send nothing to King's College. It's his right to dictate who has access to his medical records as long as it's not the General Medical Council who comes sniffing around his professional conduct for a competency hearing, and nothing of the sort of going on here. _Wilkes is the one who did wrong, not me_ , he reminds himself to contain his rising anxiety.

"I was bullied into that appointment," he tells Benington firmly.

The calm, almost disinterested expression the professor has worn until now sharpens and sours. "Sometimes we must do things which are hard, when our professional integrity is called into question."

"It wasn't about my professional conduct as much as it was your attitude toward a medical condition I have had before I even began my medical studies. Yes, it _affects_ the way I do things, but it also affords me particular protection from unwarranted discrimination. Like all students, I have the right _not_ to disclose it or make a song and dance about, as much as some would love to make it an excuse not to let me pass my courses."

"The point of the psychologist's assessment was to discover whether you can manage your studies and this profession despite what others have seen as a lack of insight on your part into how autism affects your communication and stress management abilities."

"If five years of medical school with a satisfactory grade record is not a testament to those abilities, I don't know what is. As you have not received a report from the functional assessment that I should not continue, then that, too should put an end to this discussion. If it's not enough, then maybe you should re-examine how your views fail to align with the national curriculum and quality assurance standards. I have passed; you can't now tell me I shouldn't have."

Once again, he surprises himself with his borderline angry frankness. He has always been direct and honest to the point of destructive, but he's aware that he could have sugar-coated his words with much more humility and gratitude to ensure that he wouldn't make an enemy out of his Educational Supervisor.

_I thought I'd lost the game, but Wilkes being expelled and me being given the neurosurgical rotation proves I won. And I won't let them backtrack on that._

"If you made a disclosure, proper steps could be made to ensure sufficient support––" Benington starts with a tone befitting a tedious lecture.

Sherlock stands up. "I will be the one to _make me_ , instead of having people think that the standards had to be lowered because I'm not like the other students. I'm not declaring or disclosing anything. Either you let me do this on my terms, to go through the same coursework and evaluation as everyone else, or I don't do it at all. I've taken steps to ensure that the difficulties of last term will not be repeated. Isn't the point of all these support systems to allow people to design their own path? As for a lack of insight, I can assure you that _no one_ is more constantly and agonisingly aware of my challenges as I am. But, unlike Sebastian Wilkes' oblivious and arrogant approach to his personality defects, I am not proud of mine and I work very hard to compensate for them."

That being said, he rises to his feet, gives Benington a nod and walks out.

  
________________________  
  
  


The wind is so brisk on the day when the term starts that Sherlock struggles to keep it from ripping the library door out of his hand. He has plenty of time to walk to the Mill Lane Lecture rooms where the email from the neurosurgical department had declared a two days' induction to the rotation would be held.

The two weeks after his meeting with Bennington have been good. He's revised all the lecture notes he'd made during the compulsory neurosurgery course, read a pile of advanced books on the topic and even had time to poke his nose outside for a bit of cycling when the weather has been good. Indoors, he plays violin when he needs a break to process all the material he is cramming. This is the reason why he insisted on bringing the violin this term, even if the other students on his floor are inconvenienced.

Instead of a mass lecture for over a hundred attendees, these two days will be a tailored workshop for the ten final-year students chosen for the neurosurgical rotation. Sherlock doesn't know, nor does he care, who the other ones are. This is what he's been waiting for, and he won't let anyone get in his way. Even if they all have heard rumours about the trouble between him and Wilkes — even if Wilkes has told them things about him — witnessing the fact that it's Sherlock who gets to continue and not that idiot as a signal to shut up and mind their own business.

Instead of picking a spot somewhere in the back, he goes to the middle of the second row. He hadn't slept much last night, but instead of anxiety it had been excitement which had kept him up. He knows what to expect — knows many of the key staff in the department after participating in research and he knows that Sharon Medyar, one of the most prominent neurosurgeons at Cambridge, should remember him from their earlier interactions. She'd been tough on him, but also told him that she'd expect him back.

Ten minutes before the start of the session, other students begin wandering in. To Sherlock's surprise, Tasha Caines slips into the same row and comes to sit next to him. It's alarming — why would a member of Wilkes' female fanclub seek him out like this? Does she want to give him an earful for getting Sebastian in trouble?

He forces himself to make eye contact. He's not going to bow down to this nonsense anymore. He has the right to be here — _needs_ to be here.

"Hi," Tasha says, and sounds… careful? A bit timid? Hesitant?

It doesn't fit with the image Sherlock has of her. Even if he doesn't understand her taste in men, he's willing to admit she's always been clever, an academic high-flyer. It's not surprising that she's among the select few who have been accepted to this competitive rotation. He knows she does research on the side just like him.

"Hello," he replies courteous, then busies himself digging out his pen and notebook from his bag on the floor. When he straightens his back again and glances at her, she's still looking at him expectantly.

"They expelled him," she says. "Maybe you already knew that. I just thought you'd want to hear it, if you hadn't," she explains awkwardly.

"I'm aware."

"You're not the only one who made a complaint. At least I assumed it had to be you? The dean said there were two other people." Sherlock realises one of the complaints had to have come from Tasha. Why else would she be privy to such details?

Tasha is looking at her hands. "I went to the May Ball with him. He got drunk, followed me to the dorm. Wouldn't take no for an answer. Turns out there was another complaint like that from last year: I knew Arabella had dumped him for something a bit like that, but for some reason that complaint wasn't really investigated, and no sanction was given, probably because it was her word against his. We could all see he had it in for you, that he kept picking on you. I guess after three complaints, they couldn't ignore it anymore."

That turn of phrase could mean that either Tasha doesn't know the extent of his troubles with Wilkes, or she is trying to be diplomatic. Sherlock realises he's fine with either option but bitter over the fact that the others had just turned a blind eye to what Wilkes was like. "Ignore that he's an idiot who thinks he can get away with anything?"

"That's putting it mildly," Tasha replies bitterly. "I just thought you two never got along the way some people simply are like oil and water, if you know what I mean?"

 _I really don't._ Sherlock nods. He has no idea where this conversation is going and wonders if Tasha has an idea. She doesn't look the part.

"I don't want to discuss him," Sherlock says, and wonders if it's a rude thing to say. He doesn't have any obligation to discuss the details of his and Wilkes' problems with anyone, does he, now that the matter is settled with the university?

"Yeah, I get that." Tasha gives him a reserved smile. "So, we're both doing neurosurgery, then."

Sherlock has no idea what to respond to this stating of the obvious. He glances at his watch. _Still four minutes to go. Is she doing to make more small talk?_

Tasha shifts in her seat. "How was your summer?" she asks.

He nearly laughs. Even if he was willing to discuss it, he would have no idea where to even start.

"Boring," he replies just as their first lecturer walks in.


	21. You Can Do This

**— Eight years after Cambridge —  
  
  
**

It's half-past eight in the morning, and Sherlock is deeply dissatisfied.

He grabs a piece of tissue from a wall receptacle, wipes off a name on the whiteboard, grabs a pen and writes down "Watson", instead.

Jo Cranitch, the Ward Sister, happens to be walking past. "You can't change the assignments without the permission of whoever's in charge of them today."

"It's my OR, so I am in charge of it." At the National, everyone had accommodated Jan Andreasen's wishes of who he wanted in his team. He was the best, and he'd chosen Sherlock to be his mentee, so shouldn't the same courtesy have been extended to him? Here at King's, where he's worked for months now as a registrar, nobody has yet understood that a neurosurgeon works best when they get to pick their team, and if they want Sherlock's best performance, then it should be obvious they ought to let him pick his people, one of which he always would want to be John Watson.

It's not just because of their growing relationship. It's still all new, both at home and at work, and he is tentative about that side of their connection. They are being careful about keeping their personal relationship private; John seems to prefer it that way. Lestrade knows, but Sherlock is under the impression that he's the only one. The fact that he wants to work with John is professionally logical. He's a decent neuroanaesthetist without any obvious skill deficiencies, and he _likes_ Sherlock, which is a major plus when other people get on his nerves or disagree with him. John liking him, _really_ liking him — as opposed to someone just having to put up with him because they're related — means that John wants him to be happy and to do his best. John cares about patients and is good at talking to them. He should do that for Sherlock so Sherlock could focus on more important things.

Cranitch crosses her arms. "Not in charge of anaesthesia, you're not."

"Then who is?" Sherlock demands.

Cranitch raps her knuckles on a name written at the bottom of the whiteboard next to "Ward Sister". The board says "Chief Cons., Anaest." and next to it, written in messy blue marker, stands "Watson".

"I can't see what the problem is," Sherlock scoffs. "He's available, and he's in charge of assignments. I'm reassigning him. I'll just need to tell him."

The Ward Sister shakes her head as she strides off down the OR unit's main corridor.

"Tell me what?"

Sherlock turns when he hears the voice of precisely who he needed to find. "Ah, John. I need you to gas for my case. I have a microvascular decompression for trigeminal neuralgia; the MRI showed a possible ectatic vessel in the posterior fossa, so I'll need to go in through the––"

"That sounds great, but I can't."

"What do you mean, 'you can't? Of course, you can. You're perfectly competent to do this procedure." Why is John so obtuse today?

"I'm on training duty today with one new trainee to oversee and two registrars to watch over because we've got one neuroanaesthetist off sick and another on holiday. Hall shouldn't have any problems gassing for you; he's more experienced than I am. Plus I assume he's met with the patient and made a plan. I don't know anything about––"

"I was just explaining it to you if you'd listen. Hall doesn't explain why he can't do what I tell him to do; he just gets flustered. I find it most frustrating. I want you for this."

"I can't always handle all of your cases, Sherlock. I've got other duties."

"If they had any sense, they'd redesign your workload so you could be paired up with me."

John gives him a smile he has trouble identifying its meaning. "I like doing the occasional non-neurosurgical anaesthesia, you know, and we're all in charge of trainees."

Ah, the irony means the smile is teasing. He is getting better at interpreting John's facial expressions."I don't want to do anything but neurosurgery, so why should you? Other people are distracting and annoying. You, at least, explain things to me."

"Thanks, but… You'll be fine with Hall. Just _ask_ if he doesn't tell you what's going on."

"He doesn't like me."

"That might not be true, and even if you don't get on personally, it doesn't mean you two can't work together. He'll appreciate anyone who's good at their job, but he's not just the most social of blokes. You like silence, too, when you operate? Better than… what did you call it… "inane nattering of lesser minds"."

"I don't _want_ to deal with anyone else. I want to deal with you." John is making this complicated for reasons he doesn't accept, and it's putting him off his surgery, which is frustrating.

John puts a hand on his shoulder, wearing what looks like an amused expression. Sherlock's mother was often exasperated with him, but she was rarely amused in what on John looks like a rather benign manner.

"You'll be fine. Tell you what — I'll pop in at some point when I can, to ask if Hall wants to participate in ordering in lunch or whatever. If you've got questions, still, we can have a chat together, the three of us."

Sherlock sighs, lips pursed. John's hand on his shoulder is firm and warm, and he likes it. They've kissed numerous times after moving in together last week, sat together on the sofa. Last night, he had plucked up the courage to spread himself all over the sofa and place his head on John's lap. John had _played with his hair_ , a concept which had never occurred to him could be enjoyable as done by another person. Usually, Sherlock is just annoyed if someone touches his curls because it often shifts them and messes them up. Sherlock would very much like to try _taking things into the bedroom_ , as he has heard people phrase it, but he doesn't know how to go about suggesting such a thing. A big part of him fears he might have somehow misinterpreted John's intentions and that such a proposition might put him off, possibly even evict him. Victor hadn't wanted that with him, and keeping him as a friend had been a much better option than alienating him with fumbling advances. No, Sherlock has decided to leave this to John's discretion.

"I won't say that's acceptable because your I find your reasoning about the division of assignments for neuroanaesthetists illogical, but if there is no alternative, I'll tolerate it," Sherlock says and is proud of himself for being so charitable.

John removes his hand, leans on the wall next to the whiteboard. "A simple 'okay' could also have worked without all the insults, but I'll take it."

  
_______________

  
Four hours later, the trigeminal nerve decompression is done. It had been more tedious than anticipated — no complicated vessel structures, after all. Sherlock decides that he's not going to trust _that_ particular neuroradiologist again, only his own judgement. The surgery hadn't taken long, but in terms of medical interest, it had been the equivalent of expecting a hiking route with mountain scenery and getting a car park instead. He knows registrars in their final year of training don't usually get to solo such rare surgeries, but he can't see what the difference is in the level of difficulty between this and what he's already done on his own in terms of aneurysm clipping and posterior fossa brain tumour surgery. Maybe his new superior, _Gavin or Gorman and George or whatever_ Lestrade has enough intelligence to have realised Sherlock works best without constant interference from other surgeons. He knows what he can do and knows what skills and knowledge he still lacks. He's asked for help when he must, as long as Philip Anderson is not the only Consultant available. At those times, he's better off just trying to cope on his own. How have the other Consultants not picked up on the man's inelegant, shoddy technique and overcautious decision-making?

Having been efficient with the trigeminal nerve leaves him plenty of time for lunch and for checking that the lower-level trainees and interns handling the ward have done the discharges of his patients correctly. Then, he'll need to go back to talk to John so John will come with him to talk to the patient he'll be operating on tomorrow. Well, _hopes_ to be operating on. Even he can recognise that convincing her might not be very simple.

Just as he is on the brink of deciding to ignore the pitiful offerings of the staff canteen and slip into the coffee shop across the street, instead, his phone vibrates in his pocket. It's Mycroft who has, unfortunately, realised that Sherlock has a harder time ignoring texts than calls because he can't resist reading them and then feeling the pressure to react.

_You need to tell Mummy. MH_

Sherlock steps out of the queue and marches towards the steps leading to the entrance hall, instead. He most certainly needs a triple espresso.

_I need to do no such thing. She'll find out only when I need her to. SH_

_And how is that need defined? MH_

Sherlock scoffs at the phone and slides it back into his pocket. _Oh, for the love of God, what's the rush?!_ Mycroft had called yesterday evening — Sherlock swears the git has some sort of a sixth sense regarding any new development in any family member's life and always the perfect excuse for calling such as their father's birthday present, which had been the topic of yesterday's brotherly communique. He'd heard John's voice in the background which he then required Sherlock to explain. Mycroft had then tediously insisted on some oversimplified, imbecilic definition of his and John's relationship, with the word 'boyfriend' enunciated with disbelieving astonishment and the sort of snoot his brother has always had for the comings and goings of lesser minds.

 _'You live together, yet have failed to define the boundaries of your relationship? I must say it sounds so dreadfully typical of you. Where on Earth did you find this man, Sherlock?'_ Mycroft had asked.

' _We work together. He's an anaesthesiologist.'_

Sherlock finds that their current arrangement is quite satisfactory, and if its _undefined boundaries_ irritate his brother, then all the better. It has been a most fascinating few weeks, observing and participating in the developments between John and him. Sherlock has never had any expectations of what he thinks should happen, only hopes of what _might_ happen, if John truly decides he likes Sherlock enough to put up with him long-term. Every step forward, every new development of physical intimacy is an experience fascinating enough to keep his brain occupied even to the point of distraction at work. Based on his dismal track record of dealing with people, he can hardly assume that John will want to be any of the things Mycroft has just offered as a potential description of relationship status, so he'll take whatever he can get. So far, John has proven outstandingly accommodating; so far, the man seems to view Sherlock's behaviour as just whims and quirks instead of condemning his faults.

Yesterday, John had insisted on cooking dinner. Sherlock had asked if this was something John did on a regular basis. John had said no, but that sometimes a home-cooked meal was nice and it would make for a lovely date to do that and maybe open a bottle of wine. Sherlock doesn't care for wine, of which he had informed John. This had led to a conversation about his food preferences and dislikes, and John had changed his menu to accommodate the list of ingredients Sherlock had informed him were intolerable. In a way, the way John had acted as though it wasn't too much to ask at all that celery, among other things, was kept as far away from Sherlock as possible, felt even more pleasing than the fact that someone wanted to prepare a meal for him.

 _Sentiment_. John Watson has a strange way of coaxing that forth in him. So much so, that he pulls his phone back out of his pocket and taps out:

 _Piss off. SH,_ to Mycroft. The pompous git will probably now tell Mummy about John, and there will be a call from her, demanding details and expressing concern over who this man might be and what he wants from Sherlock. She'd never assumed that what someone would want _is_ Sherlock. No matter how many years have passed since Sherlock left home, his private life is never seen by his family as private.

And that's what makes John Watson so singularly, spectacularly special. That he acts as though he is constantly very smugly pleased about Sherlock's existence even when Sherlock forgets some arbitrary co-habitation rule, forgets to pick up fresh milk when they run out, or he misses a cue of what John wants. Should he now cook a meal in return? He should google this, though some of the advice he has found online has amused John when shared with the man afterwards. Still, things are new, and Sherlock is finding it an interesting challenge to find ways to impress John with his dedication to their as yet undefined relationship.

  
_________________  
  


  
"What are you doing?" Sherlock asks over John's shoulder from behind the mask he'd donned before walking into the OR where John is handling a wrist fracture repair. Orthopaedics and traumatology work is so inelegant and tedious — hammers and nails and plates. None of the finesse of intracranial surgery. Granted, there is the occasional reattachment of small nerves and blood vessels, but it's still just limbs and other musculoskeletal structures.

John flinches where he's holding a needle, and the patient on the table cranes her neck a bit to see who has arrived.

"Christ, Sherlock, a bit of warning before you start lurking like that!" John protests.

"Doctor Watson?" The patient, an elderly woman, asks.

"It's alright, Mrs Parry. This is Mister Holmes, one of our surgeons. I'm sure he has an urgent question which cannot wait."

"I need a word about tomorrow's patient. I need you to come with me to talk to her."

John cocks his head towards the sterile table next to him on which a small nerve stimulator, a needle and a syringe of clear liquid have been placed atop a sterile cloth. "I'm in the middle of something here. Can't it wait?"

"But I'm free _now_ , and someone else can do that."

"I've explained things to Mrs Parry so I'm sure she'd be more comfortable if I was the one to follow through with the plan," John explains, his tone a bit strained but still reassuringly patient.

This is what Sherlock likes about John. He explains things in a way that doesn't make Sherlock feel singled out. He explains things in a way that makes Sherlock feel like he deserves an explanation of why John can't do what he wants right now. John has strange priorities, though, just like all the other anaesthetists. He has specialised in neurosurgical anaesthesia, so surely, he should be able to leave the scene of some pedestrian nerve block and join him to attend to a neurosurgical patient?

John, who had twisted his torso to talk to Sherlock, turns back to face the patient's armpit. "I'll come find you once I've done this; I'm sure once the block kicks in, Otto can keep an eye on the rest of the procedure."

"But we could already be talking to the patient, and I could then get on with other things."

John grabs the bevelled needle with a nerve stimulator cable from the table. "Sherlock, I'll _find you later_. We can't talk about that case here, with another patient present," he reminds Sherlock.

Sherlock's eyes narrow as he takes in the sight of Mrs Parry. Very quickly, he has deduced seventeen things about her, one of which serves the situation perfectly. He approaches the table and snatches off both her hearing aids.

"Oi!" The circulating nurse protests.

"John said he'd explained the plan to her. There's no information that needs to be conveyed to her right now."

"Except if and when she feels certain stuff in her hand as I locate the nerves," John snaps. "She and I have to communicate _now._ I will _talk to you later_ , Sherlock. Now give Mrs Parry back her hearing aids."

He gives the devices to the circulating nurse holding out her palm. "How much later?" Sherlock asks timidly, sensing that John's patience is running out. He gets snippy when that happens, and he's now snapped at Sherlock once.

John doesn't reply, and Sherlock knows better than to strain his new flatmate's nerves any further, so he retreats from the OR.

  
_______________

  
  
By the time John walks into the OR unit break room, Sherlock has consumed eight biscuits and three cups of coffee. The caffeine is giving him a pleasant buzz but what he really craves is a cigarette. He hasn't left the OR unit one for fear that he'll miss John leaving the OR. After observing the man's habits for four weeks, now, he has established that unless it's between 11 am and noon, the first thing John does after leaving an OR is going to the break room to drink water or tea. He only tends to consume coffee in the mornings, which suits Sherlock's purposes because he wants coffee before leaving for work, and caffeine improves on John's reaction times when driving approximately 13 per cent. In London traffic, that could be a very crucial 13 per cent. For that, and because he wants John to be satisfied with their co-habitation, Sherlock had agreed that John's percolator could sit on the kitchen counter and it could be used in the mornings. The resulting coffee is inferior to espresso, but Sherlock thinks he might be able to educate John about coffee quality eventually.

"Oh," John says when he spots Sherlock who is rising to his feet and tugging at his jacket lapels. He had calculated that it would take at least thirteen minutes for John to finish the nerve block, assuming the anatomical locations of Mrs Parry's nerves were not atypical, and that had been just enough time to change out of scrubs and into his suit. He prefers to wear a suit when he goes to talk to patients. They won't mistake him for other staff and can more readily accept that he's a Consultant. Well, _almost_. It's only a lie of omission that he doesn't correct them that he's still a registrar. He hangs his nametag from his pocket so that it would be harder to read. In terms of the Royal College of Neurosurgeons' competency charts, his skills are way more advanced than what is expected of a newly minted Consultant, so it's all just semantics.

John had commented favourably on how one of his older suits looked, so he had had a new one made in a similar fabric and silhouette but with a slightly tighter fit around his buttocks. John had been glancing at those in a manner which also seemed favourable.

Now, he cannot deduce whether John's 'oh' is surprised or not, and whether it is disappointed or delighted. Not knowing is infuriating.

"I haven't had any time to think about tomorrow's OR assignments. I'm the OR unit's supervisor anaesthetist for the rest of the week, so I might not be able to––"

Sherlock cuts him off. "I need you to come with me to talk to Mrs Haines; as you pointed out earlier, it's more logical that the same anaesthetist handles the case who has already met the patient."

He expects John to argue, but instead, he looks a bit tired and haggard and slumps down in the chair Sherlock has just vacated. "Get me a cuppa and tell me, then."

After so much coffee and now, facing the excitement of sharing the case with John, Sherlock practically vibrates. "She's a twenty-eight-year-old––"

" _Tea_ , Sherlock."

His next words are suspended in his larynx, and he lets go of them by breathing out. He goes to the dispenser and runs a disposable cup nearly full, adds some milk since John likes that. He takes only milk with tea and coffee, no sugar.

Once the cup is deposited safely between John's palms, he waits for his cue, nearly rocking on his heels in anticipation. It's an interesting case, and he likes sharing those with John because John doesn't berate him for being odd or morbid because he gets so excited when there are salient surgical details.

At least he has John, who is even more fascinating an entity than most of his surgeries, to observe while he waits. Truth be told, he hadn't paid much attention to the man during their first few encounters at work — he never does pay much mind to anaesthetists. There is something very strange about doctors who want to be in the operating theatre, yet are content not to be the one operating. Granted, the specialty offers excellent training and opportunities for work in critical and emergency care, so certainly there is something there for adrenaline junkies, but many of the more OR-oriented ones seem a rather calculating, peaceful bunch who content themselves with working in the background as the equivalent of airway and blood vessel plumbers who stare at patient monitors all day when not drinking copious amounts of coffee.

Judging by what Sherlock know knows about John, he's more the restless adrenaline addict type. Perhaps that's why he'd chosen neuroanaesthesia as his subspecialty — he has taste and appreciation both for the elegance of elective craniotomies and a craving for the excitement of emergency neurosurgery.

The first time he'd really noticed John, really paid attention, is when John had called him out for wanting to continue a surgery for the sake of practice when the patient had already cerebrally expired on the table. That moment, John had turned from who Sherlock had mistakenly assumed was just another harmless, uninteresting anaesthetist to someone who could command a most formidable presence. In short, that night in the OR where Sherlock had assumed that he was in charge, Captain Watson had taken over, and it had greatly confused and intrigued Sherlock how he didn't even mind. He'd only realised after the fact why he'd not been livid at being spoken to in such a manner. He'd been chewed out by senior anaesthetists and surgeons before — well, they'd _tried_ — but John had done it in a manner that demanded that he do better. Instead of just chastising a hopeless case, John had seemed convinced that Sherlock could act different, _be_ different if he so chose. Less a case of being told what he "should" do and criticised, more a case of being advised what he could do, if he tried. He challenged Sherlock, and at that moment, Sherlock had realised his uninterested prior dismissal of the man had been a grave oversight on his part. John had told him off, but John had also respected him, somehow, instead of thinking he was just some unforgivable freak.

Sherlock hadn't been in a good place then. He had the lawsuit hanging over his head, a need to prove his worth at King's after a chaotic and not entirely voluntary departure from the National. He felt more alone than he'd felt in a long time, exacerbated by the death of his mentor. The way his peers had treated him afterwards, descending upon him like vultures on a carcass, had reminded him painfully of things which had happened during his school years and at Cambridge during his fifth year there. The debacle at the National was the second time Mycroft had come to his rescue when he'd started using. It had nearly cost him his career, but thankfully, after rehab, his stellar research record was still worth something, and King's had been willing to give him a chance. Dr Adler's glowing recommendation had also helped, but he'd still felt as if he was on probation, with everyone just waiting to pounce, accusing him of being unfit to be practising neurosurgery.

When he'd met John, he was teetering at the brink of yet another potentially career-ending crisis. He was tired of never feeling safe, tired of fighting against the tide of his own failures, based on the way in which he was different and would always be different.

He still doesn't know what had made him trust John — after all, John had had some very unfavourable things to say about it at the start, and he'd said them in front of a theatre team — but Sherlock had felt desperate for help, desperate for someone to listen.

John had been the right choice. Instead of judgement, he'd only offered acceptance, and together they had solved the case of what had gone wrong with the patient case which had threatened to drag him through the courts. Instead of defective, John thought him amazing.

The more time he spent with John, the more safety he'd found in the man's acceptance. Why _wouldn't_ Sherlock have asked him to move in with him? John _likes_ him.

He clears his throat, stands on his tiptoes as far as his OR trainers will allow to check how much tea John has left.

"Go on, then," John prompts with a grin, "Before you'll burst."

"Twenty-eight-year-old woman with well-managed hypothyroidism and a body-mass index of thirty-four. Her mother and grandmother both developed breast cancer at a relatively early age, and Mrs Haines has just been diagnosed with a relatively small lump in her left breast. There is a suspect lymph node in the armpit, a round shadow indicating metastasis in her left lung, and a needle biopsy showed ductal carcinoma which is, of course, stage 4 due to metastasis. She presented not with the lump which she assumed was consistent with her status but with a grand mal seizure at a shopping mall. There are two metastases: one between the pons and the cerebellum and one in her occipital lobe. I've devised an approach which should allow me to remove both by starting with a lateral suboccipital craniotomy, then extending towards the suboccipital midline."

"That would require some pretty fancy repositioning during surgery."

"Yes, from concorde to sitting without compromising the sterility of the field. And a complicated bone removal and refitting, and––" Sherlock steeples his hands together and paces the length of the break room. They're alone there. "––I will have to carefully navigate around the pontine arteries and avoid puncturing the vein of Galen."

"Have you done anything like that before? Has… anyone?"

"I have not, but I know the anatomy. Lestrade has given permission for this and will be present in the OR. Not scrubbed in unless he needs to."

They'd had a heated discussion about this — the Chief of Neurosurgery had insisted that he should be lead in the case, not a registrar, but Sherlock had got him to admit his skills were on par with all of the Consultants — save for Lestrade who is admittedly very good — when it came to operating the areas of the brain at the back of the skull.

"Shouldn't you go talk to the patient with Greg, then?"

"Is that what he's calling himself now? Why?" Sherlock is quite certain the man's name is… _Grant? Glen? Giorgio?_

"That's his name." John chuckles and blows on his hot tea.

"The patient thinks the problem is not the surgery, but what happens after. The lung metastasis can probably be surgically removed, but that would have to be done in a separate operation which complicates matters further."

"What do you mean, what happens after?"

"The patient is pregnant."

John lets out a breath and grimaces. "Fuck. What trimester?"

"First."

"Double fuck."

"That's… not how I would have summarised the situation, but I grasp your sentiment."

John is clever so he must have understood immediately that while surgery can often be carried out during pregnancy without any adverse effects on the foetus, advanced breast cancer would require extensive radiation and chemotherapy, and during the first trimester, in particular, they would likely have devastating effects on foetal organ development.

"The surgery to remove the breast was yesterday. Her nurse at the plastic surgery ward informed me that she wants to decline all other treatment beside the operations to remove the metastases. It won't help. She will die if she doesn't have chemo and radiation, which would render the surgery useless."

"She wants to carry the baby to full term."

"Yes. You must convince her to terminate the pregnancy. She will die otherwise, and there is little point in complicated surgery is she is going to destroy the results."

"She isn't _destroying the results_ deliberately, Sherlock — she wants to have her baby."

"Shouldn't she want to live?"

"Well, you could argue that the treatments won't render her infertile. She could get pregnant again; even if she has to wait a few years, she'd still be of viable age."

"She _is_ nearly infertile, and so is her husband. The pregnancy was created through artificial insemination of her harvested ova. This was her last ovum. Microsurgery was needed to find sperm cells in his testicles; they went to Berlin for that since there are no centres in the UK yet offering the method."

"Her last chance."

"It's also her last chance to live."

"There's no guarantee that she'd be able to carry the baby to full term if the cancer is allowed to spread uncontrollably."

"Oncologists say she might have a year without oncological treatment so it could be possible."

"But there's no way she'd survive if she began treatment during a later stage in the pregnancy?"

"Oncology says that what they'd have to use would undoubtedly harm the foetus and threaten the viability of the pregnancy."

"She needs to choose. Christ."

"I don't understand why she'd even want to think about it. Shouldn't she want to live?"

John sips his tea, looking thoughtful. "It's complicated, I guess. We're not women, especially not pregnant women on our last harvested ovum."

"You have to speak to her, explain all of this."

"Me? I'm not her surgeon, you are."

"But… I can't," Sherlock admits from behind clenched teeth. "I _want_ to do the surgery, and she _needs_ the surgery. All that stands between the surgery and her are…" He flaps his wrist in frustration, " _words_. Words, John. Words I don't have. You do. You understand what has to be said and why. Hormones make people irrational. Pregnancies make people emotional. I can't manage that sort of nonsense."

"How did you manage to get through the OBGYN rotation at med school? This sort of conversation has to have been a part of your training."

Sherlock shudders, remembering the horrors. "I didn't do very well on that front." He looks away, trying to keep memories locked up. "Communication with patients is not my fortè."

"Yeah, the patients can get to be irrational and emotional, and we have to empathise with that. But patients don't expect us to be able to understand how they feel about things. No doctor can have had all the life experiences a patient's gone through. We can't know how they feel, and we don't have to. We just have to appreciate the emotional impact of what they're going through."

"Oh, I _appreciate_ the impact, because it complicates my work every damned time. How many times are you going to make me say it? _I.can't.talk.to.her_."

"Yeah, you can," John replies without missing a beat. "I've seen you talk to patients. You're alright, mostly."

Sherlock blinks. He can practically feel his brain grinding to a halt because the expected outcome of this conversation has just fallen down a trapdoor, leaving him without a guidewire to manage the rest of it. "But I… _can't_?" He tries.

"You're her surgeon; you have all the facts, including the potential prognoses of each option. You explained it to me just fine and saying that it's her last chance to live is not irrational sentiment, Sherlock, it's a fact. Nobody's probably ever told you that you couldn't be a neurosurgeon, and being one includes telling patients things." He makes a face. "Alright, admittedly you could do some work on your… diplomacy, but if you were completely crap at it, nobody would let you cut their head open. And they do, all the time."

"Often, they don't know whether there would be other options than me or not. What makes you think people haven't told me I couldn't be a neurosurgeon?"

John looks confounded. That's one emotion Sherlock knows how to recognise, especially in John, whose confusion is very expressive. "Well, you can't have become that brilliant overnight. They must've picked up on that in med school."

"Rare was the person who did. Most of them told me that since I can't deal with people, I couldn't or rather shouldn't be a doctor."

"But…" John's confusion seems to be shifting into alarm; "…you're so good at this."

"Some of it. The operating and the clinical decision-making. _Communicating with patients_ , not so much."

"As much as people say they want an empathetic doctor, in my experience, they're willing to accept that surgeons can be a bit different."

"Thank God for small mercies."

"They want facts. They have enough emotions on their own. _You_ have the facts. You just have to deliver them in a way they can understand."

"But it's so difficult!" Sherlock huffs in annoyance. John isn't understanding anything right now. Everyone, especially people who know him well, has always told him he has no skills in interacting with other humans. Now John is telling him differently. Why?

"You think it's any easier for me, telling people bad news?"

"Yes!"

"It kind of hurts me, too, Sherlock, when I have to do that. It's exhausting and sad, and often I'm a bit distracted after, which is a bit not good if I should be focusing on something else. You don't have that problem, at least not to the same extent. You can compartmentalise, function even when everyone else is affected, and that's also something a good surgeon does. Remember that kid last week, the one who got hit by a car?"

It had been a trauma alert to which Sherlock, as the neurosurgeon assigned to carry the consult phone that day, and John as a senior anaesthetist overseeing trainees that day had been summoned. A three-year-old girl had been hit by an SUV; she'd wandered away from the family car while the mother was strapping her baby brother into his car seat. She'd had an open skull fracture and a devastating brain bleed with massive, herniating brain swelling, and it slowly became obvious that could be done to save her, yet they all had to make an effort to try. The horrific scene in A&E had while not exactly paralysed the team, had certainly affected all concerned. John hadn't treated such a small child with a brain injury in years, his trainee was rather inexperienced, and the trauma leader was visibly shaken. He'd admitted after the whole thing was over that his daughter was the same age.

"The only one who was able to take full leadership, make the decisions, deliver precise instructions and make a swift diagnosis was you," John tells him. "You're good in a crisis, and not because you don't have empathy — I know you do, I've seen it, especially with kids. No, you're good in an emergency because you have the clinical focus required to look past what affects other people so much it can interfere with their work." 

All Sherlock remembers in this regard is being annoyed by how others had been so affected; why should a patient's age have anything material to do with treating an injury beyond the obvious physiological factors that needed to be taken into account. Aren't all lives equally valuable and worthy of being saved if it is possible?

"You told those parents the facts. Concisely and simply. It didn't matter that you didn't get all touchy-feely as you like to put it. When you told me about the pregnancy, I got uneasy, whereas you can step aside from all that and just look at the medicine. That's what this Mrs Haines needs you for."

"Oh. So, you think I can––"

"––be kind of the best person for the job. Yeah, I do."

Sherlock's brows knit together. John has a strange and wondrous ability to keep surprising him. He's never been told he'd be the best person to have a difficult conversation with someone.

"Just…" John is now pinching the bridge of his nose, "…when you talk to her, call it a baby, not a foetus."

"Why? It's not a viable child yet. It's not been born."

"It's psychology, Sherlock. You must have had to deal with patients in highly distressed mental states before now."

He has to draw breath. _Not going there._ All he can manage is, "The psychiatry rotation was even worse for me than OBGYN. It was _torture_."

"For her, this is torture. It's not a foetus, it's her _child_ , even if it's still unborn. Calling it a baby makes her feel like you understand why it's important."

"I'm not the best person for the job, because this wouldn't have occurred to me at all." Is John flattering him just because John doesn't want to help him? He wishes that all his previous experiences with medical professionals didn't make him so wary, so paranoid about what people tell him.

"Taking pointers is not the same as being crap at it. All doctors learn from example how to deal with these kinds of talks. I didn't know how to deliver shit news when I was a medical student. I learned how, and I learned to accept it's not easy for anyone. Some people are just more uneasy than others. Doesn't mean they can't do it."

"You trust me not to make a mess of this?"

"Yeah, I do."

John is unique in his ability to make Sherlock feel encouraged to try. That has never been Sherlock's mother's stance on things. If something was difficult for him, Violet Holmes always told him he shouldn't even try because he was bound to fail.

  
_______________

  
  
At half-past five, Sherlock walks into the hospital staff parking garage and finds John sitting in the car.

"Where the hell have you been?" John demands when he opens the door and slides into the front passenger seat.

"Assisting Lestrade in an emergency clipping of a massive berry aneurysm of the anterior communicating artery."

"I thought you only had that one morning OR case."

"Yes, but I couldn't pass up the chance to see this case. I don't have enough of them under my belt yet."

"That's just as well, but you have to _tell me_ if you're going to be late leaving work."

"It's _patient work_ , John; I assumed you would agree that it takes priority."

"You volunteered for the case."

"I don't see what relevance that has."

"It has the bloody relevance that I've sat in the car waiting for you for an hour and a half now!"

"You could have gone to… a pub? To have a… pint?" Sherlock scrambles to suggest. John is angry with him, he can tell, but he can't quite grasp why.

"I don't _want_ to go have a pint and sit around wondering when you'll show up, Sherlock; I want to go home after running around all day."

The irritation in John's tone is obvious, and Sherlock makes a mental note to keep in mind that John appreciates being up to date about schedules even if changes in them are caused by clinical work. He's made a note of many useful things about John such as how he takes his tea and coffee, that, quote, _'he likes his doctors clean-shaven_ ' when kissing, his porn preferences — a varied selection of both heterosexual and gay footage, with one of the most common categories he peruses being first-person point of view of fellatio regardless of gender — that he's not a morning person, that his taste in films is deplorable but watching action films on the sofa is very tolerable when done in close proximity to the man, and that he likes Sherlock's backside. At least his eyes often drift to it while wearing the same expression he does when he's not had a meal for some time.

John is irritated with him right now, and John is outstandingly important, so something needs to be done to fix things. He is unsure whether the conversation has reached the point where offering certain placating words would be pertinent, but he decides to err on the side of caution.

"My apologies," he offers.

"Okay." John pats the steering wheel with his palm, then yawns and pulls out.

Sherlock buckles his seatbelt. He decides not to say anything more because his apology seems to have gone down well and he doesn't want to ruin that.

"How'd you talk with Mrs Haines go? I managed to get myself assigned to neuro tomorrow, but it depends on whether we have full staffing tomorrow whether I have to take over the aneurysm case or if I can join you."

"She agreed to have the surgery. She doesn't want to die. She said she would want her child to have a mother, but that statement was an oxymoron. There won't be a child."

"She means she doesn't want to die if it would mean she couldn't be the baby's mum."

"Not all mothers are good ones."

"I know. Could have swapped mine for someone who actually gave two shits about her kids or at least cared about them more than she did for a drunk of a husband who'd just leave her, anyway." John's tone is angry.

"Some mothers think they care, but they don't," Sherlock says. He doesn't really want to talk about his own. "Someone else could have raised the child. She made the right decision, of course, but she didn't seem to comprehend the option of having the child and not raising it."

"It's her child. I don't know what it's like, but I guess it's a special thing."

"A special thing that makes people irrational."

"There are lots of those, some of them pretty nice."

Sherlock is incredulous. "Such as what?"

"Attraction. Love. Head over heels and all that. Workplace romance."

Sherlock scoffs, even though he does sense that John might be referring to the two of them.

It wouldn't do to gain a reputation as someone prone to sentiment at work. Except that John seems to think sentiment might have a place in some parts of medicine, and he has even commented favourably on Sherlock's attempts to express it. In fact, one such rare moment had led to that conversation which Sherlock still occasionally doubts could have happened to him of all people. He finds it amazing that someone like John expresses his admiration and interest towards him.

"I couldn't possibly know," Sherlock says. He's not one to try irony often, but this time he chooses not to suppress his smile, hoping that John will understand. 

That makes John laugh, and astonishingly, it's someone laughing _with_ Sherlock instead of _at_ him when it comes to comprehending matters of emotion.

**Notes for the Chapter:**

> One more chapter remains, and I promise it will offer even more catharsis for all you lovely readers who have laughed, cried, torn out your hair and cheered our fledgeling neurosurgeon on with us.


	22. Epilogue

————— **Seventeen years after Cambridge** —————  
  


Predictably, Sherlock can be found in the queue to the free coffee dispensary in the exhibition hall after the first morning's lectures end. John has no need for more caffeine before lunch, so he leaves his husband to it after telling him that he'll be on the trade floor. He wants to have a word with some of the regional anaesthesia equipment reps to see if he could negotiate a better bulk deal for their nerve block needles. He'd met up with a few other Clinical directors over lunch and learned that King's was really not getting the best prices. This weekend, Liverpool has the honour of hosting the annual conference of the European Association of Neurosurgical Societies. Despite the name, many neuroanaesthetists are also in attendance, as well as administrative staff, so the companies peddling their wares in the exhibition hall have not limited their offerings to just neurosurgical instruments and subspecialty anaesthesia equipment.

Besides being important for sharing new scientific ideas and for networking, conferences are also a nice break and social occasion for medical professionals. There is always a social and cultural programme as well with dinners, perhaps even a ball. As usual, John and Sherlock had made an extended weekend trip out of it. They are staying in town for the duration of the conference and afterwards, they have plans to drive north to the Mercure Blackburn Dunkenhalgh Hotel & Spa in Clayton-le-moors for a few days. A 700-year old country hotel, it's advertised as a good mix of old and modern with beautiful grounds. John is hoping to pry the laptop out of Sherlock's hands long enough to drag him outside for some fresh air long walks before nice meals and perhaps an early night's fun between the sheets.

First things first, though. John squares his shoulders and heads for the Pajunk stand. The company's popular, bevelled nerve block needles offer excellent ultrasound visibility, but quality comes at a price. John is hoping that the company might meet him halfway when it comes to that; the King's ortho and hand surgical services use a large number of these needles per year.

He approaches a young woman manning the booth who instantly offers him a foil-wrapped piece of chocolate with the brand logo before John's even had a chance to introduce himself. She gives him some leaflets which he shoves into his conference bag — in all honesty, he often tosses the whole thing right after a conference, preferring to browse online for versions of conference abstracts and product specifications.

He explains that he'd like to discuss large order pricing.

"Oh, I'm sorry I can't help you with that; you'll need a word with our joint managing director for the UK," the cheery woman responds.

"And who's that?" John asks, expecting to be given a business card.

The woman leans over the counter, eyes scanning the thickening crowd at the junction of the large Pajunk booth and the next which belongs to GE Medical.

"Sebastian!" She calls out.

A man in a suit, standing half-concealed by a cardboard column turns around. He's only slightly taller than John, wearing a dove-grey silk suit with no tie and a calculated thousand-watt smile. He strides confidently to John and seems to size him up, finally settling his gaze on the nametag hanging from John's neck. After scrutinising the name and title on it, his grin widens as he firmly meets John's gaze and his hand shoots out for shaking.

"Sebastian Wilkes, UK operations. What can I do for you…" He leans down slightly, hand still grasping John's uncomfortably tightly before letting go, "…Mister Watson?"

"Not a surgeon, so it's _Doctor_ Watson," John corrects and puts his bright yellow, ugly-as-hell conference bag down between his ankles so it won't tip over. "I'm in charge of the surgical services at King's College Hospital in London and was wondering––"

"One of our _best_ clients!" Wilkes' declaration interrupts John. The rep even claps a hand on his shoulder. "I heard the Trust was considering breaking ground for a new, partly privatised ortho unit. Any chance we could partner up on what you'll need in terms of equipment?"

"That's what I actually came to––"

"No better place than London to tap into the private sector, eh? We should have lunch," Wilkes declares.

Something about his alpha rhinoceros manners and smarmy smile is beginning to grate severely on John's nerves. "I wanted to talk to someone about our bulk purchase pricing."

Wilkes is looking at him like a steak on legs. John has seen this before: someone decides he's high enough in the King's ranks that buttering him up should coax forth some juicy deals. The NHS is a massive source of income for both pharmaceutical companies and equipment manufacturers, and the latter have fewer restrictions imposed on them in terms of sponsoring doctors and donating things to garner favour.

Wilkes leans down, grabs John's yellow bag and deposits it by a pair of armchairs arranged to the side of the booth counter. "Sit, sit; good thing I've held on to a set of tickets for the Schroeder Ball tonight. Bring the wife, we'll have some _fun_ before talking shop! I'm sure we can come to a deal that'll both leave us satisfied, eh?"

John resists the offer of a seat; if this conversation gets any worse, not only will he resist the offer of dinner tickets, he will _leave_ to avoid extended exposure to this berk's company.

"Are _you_ bringing the wife, then?" John asks in a slightly biting tone.

Wilkes raises his left hand and wiggles his ringless fingers. "A wise man once said: why buy a cow if you can just keep buying different cartons of milk?" Wilkes chuckles, and his face is now close enough to John's that he gets treated to a whiff of stale liquor breath. "That wise man being yours truly, of course."

"Speaking of milk," a baritone now interrupts the conversation, "they were out."

John turns and comes face to face with Sherlock who's offering him a paper cup with black coffee. John hadn't asked for any; it is typical of the timing and nature of Sherlock's occasional attempts at being considerate in a husbandly manner to be a bit off target like this.

John accepts the cup. Sherlock is holding a second one, likely containing his own black with two sugars.

Wilkes, who had been leaning down to clear commercial debris off the table between the armchairs straightens his back and faces the two of them. John opens his mouth to introduce Sherlock, but the facial theatrics Wilkes suddenly performs tell him quickly that they must be already acquainted.

" _You_." Sherlock's tone is north of glacial.

" _Holmes_ ," Wilkes acknowledges, with a tone that isn't any friendlier. "The fuck are you doing here?"

Nonchalantly, Sherlock lifts the lanyard hanging off his neck so that the violet, gilded ribbon attached to the nametag can be seen. "Keynote speaker," he informs Wilkes and his tone is so aggressively superior that it has left snide far behind. "I see you've brought the circus into town," Sherlock says as his gaze scans the buzz at the booth. "I can deduce who the clown is."

The edge of John's lip quirks up. He's not heard such language from Sherlock since he reached some sort of a truce with Anderson. Their playing in the same chamber ensemble seemed to have softened the edges of their mutual professional dislike.

"Still a bastard, I see," Wilkes says, straightening his jacket as he challenges the taller Sherlock with his gaze. He then directs his attention to John. "I do apologise, Doctor Watson. I believe we had a matter to discuss. I'm sure Holmes won't mind leaving us to it."

"What if I do mind?" Sherlock asks, finishing his coffee in one swallow. He then crumples up the disposable cup and throws it with impeccable aim into the sweets bowl on the booth counter — to the horror of the young woman still standing there and trying to explain something in a leaflet to a pair of surgical registrars.

"Then you'd be bothering this gentleman while he's trying to conduct some actual business." Wilkes steps between Sherlock and John as if to protect the latter.

Sherlock chuckles. "I bother him daily at home; he's used to it." He lifts up his left hand to demonstrate the ring. "In fact, I believe he rather enjoys my attention."

It takes a moment for Wilkes to try to work out what this means without spraining his face. "I knew it," he finally says in a low voice. "I knew you had to be a––"

"Consulting neurosurgeon at King's College," Sherlock completes his sentence and extends his hand for shaking though John doubts he really wants to touch the smarmy git now staring at them both.

Wilkes crosses his arms petulantly.

"I take it you two know each other, then," John jokes to lighten the mood. He wonders why Sherlock doesn't just walk away — or why Wilkes isn't doing that, either. This is a pissing contest. Whatever had happened between them has clearly left neither feeling like they've won.

"We went to medical school together," Sherlock says. "Until he got kicked out."

"Until _you_ got me expelled," Wilkes protests.

"I can honestly say you put in the real work on that," Sherlock says dryly. "I merely ensured that the progression of those events reached their inevitable conclusion."

The young woman from the counter now appears by Wilkes' side. "Everything alright, Sebastian?" John notices she is looking at him quite doe-eyed.

Sherlock seems to have picked up on the same. "I see Mister Wilkes has not changed. Miss, make sure you're articulate in your rejection, or you'll have to experience what he calls his _charming persistence_ , but which others have described in much less flattering, occasionally even judicial terms." Sherlock raises an unimpressed brow at Wilkes. " _No_ is a word he never quite got around to looking up in a dictionary."

Wilkes glances at his watch so briefly that John doubts he could have really told the time. "I believe the next lectures are about to start. Doctor Watson, can I get back to you on––"

Sherlock has already grabbed his arm and begun resolutely steering his husband away from the booth.

John is chuckling as Sherlock lets go of his arm and they head for the main hallway. "I'll just have to tell the anaesthetists at King's that we had to settle for a cheaper needle brand, then."

"I'm sure Mycroft knows someone who knows someone higher up at Pajunk than that waste of space," Sherlock dismisses as they head to hall D where the next lecture they've both planned to attend will start in a few minutes.

John can't help being curious. "What'd you do to each other, then? Did you nick the last pair of theatre scrubs on your paediatric rotation? Did he break your stethoscope?" John then sobers up. Something very intense had been going on there, between the two men. "Jokes aside, it must've been serious if he was booted out."

"Perhaps I'll tell you the details one day," Sherlock says tiredly. "All you need to know is that he's a bully, a cheat and a misogynous waste of breath."

"I managed to deduce that much myself, ta," John says as they find seats at the back of the auditorium. The lights are still on and people are slowly wandering in. He realises he'd left his yellow bag at the booth. _That Wilkes creep can keep it_. "Must've felt good, though, getting to show him where you are now in your medical work, as opposed to him."

"He's probably still got a pretty lucrative career. His brand of dishonesty is much better suited to business than medicine."

John watches as Sherlock considers what he's just said. Almost tentatively, Sherlock then adds, "I don't like to make such assessments of others, of course, since I've been at the receiving end of a lot of commentary dismissing my competence and aptitude for this profession, but…"

"Reunions. Yeah, I get it. Unless they've really had a lovely class group, I suspect that the reason a lot of people really go to school reunions and such is to get back at the idiots who gave them a hard time, to demonstrate to bullies that they made something out of themselves. And you certainly have."

"Back when we were still at Cambridge, a day like today felt like a very unlikely future scenario," Sherlock admits in a bitter tone.

John slips his hand onto his husband's knee. "You think that when I was in med school, I expected to fall in love with Britain's most brilliant neurosurgeon, or that he would turn out to be someone like you?"

"Probably not. You probably expected to find a wife who'd do all the housework."

"Oi! I'm not that bloody old-fashioned!" John laughs. "I don't think a lot of people would be willing to believe what their future selves would have to say about their careers or marriages or anything."

Sherlock surprises him by placing his hand on top of John's. They're not shy about public displays of affection these days but have _mostly_ kept such things out of their work environment. Everyone at King's knows that they're a couple, and occasionally, Sherlock forgets what kinds of things are appropriate for non-private conversation in the OR.

"I never in a million years expected _you_ ," Sherlock says. "Back then, Wilkes would have been the first to tell me no one would ever bother."

John clasps his hand briefly in his own and gives it a squeeze. "He really doesn't seem like a guy whose opinions you should care about."

"Admittedly, it did feel good to tell him where I work and that I'm a neurosurgeon. And that I'm not doomed for a life alone."

"Nothing wrong with that. You've achieved so damned much, but sometimes it feels like even you're surprised by it."

The lights begin to dim. Soon, the lecturer is in full swing, and they only make it to the fourth slide of the review of recent developments in microinvasive cerebrospinal fluid disorder surgery before a paper authored by Sherlock is quoted.

"See?" John whispers. "That's your name up there, not that fuckwit's."

"I care more about the name engraved into your ring," Sherlock whispers back, then leans back against the uncomfortable plastic seat, digging out his mobile from his pocket. He rarely manages to concentrate on a lecture for more than a few minutes unless he's the one giving it.

John is left wondering about the ring comment; it appears that the appearance of that idiot Wilkes has suddenly brought on a fresh surge of appreciation from Sherlock for their relationship. He can only guess at how the guy had got so under Sherlock's skin all those years ago. He's happy on his partner's behalf even if the intensity of Sherlock's schadenfreude is a tad petty. If this idiot had hurt his favourite person, then John is over the moon that Sherlock got to witness the guy end up in what doctors often joke is the alternative for people not clever enough for medical school — being a drug or equipment rep. Of course, this isn't true, and for lots of people it's a good and sought-after career. Still, in Wilkes' case, judging by whatever had happened back at Cambridge, it seems like it had certainly not have been the guy's first choice.

Wilkes didn't have what it takes, unlike Sherlock, who is lauded as something of an era-defining genius, achieving what he'd always wanted to do — to be a neurosurgeon.

A second paper of Sherlock's regarding the thrombosis rates of the anti-siphon shunt valve design he had revised a year ago is quoted.

John leans close to his ear. "You think the author of that paper would be game for a private conference after dinner?"

Sherlock's tongue darts across his bottom lip before he adjusts his seat. "Assuming you have something interesting on offer, I'm sure he could pencil you in."

**————— The End —————**

**Notes for the Chapter:**

> Mister Holmes and Doctor Watson will return. Soon.


End file.
